This is a randomised phase II study in patients withresectable hepatocellular carcinoma (HCC). Sixty patients from across the UK willbe randomised 1:1:1 and this trial is looking at giving pembrolizumab andlenvatinib before surgery for people with liver cancer.

Before surgery patients will have one of the following:

Cohort 1: pembrolizumab by it self (200mg IV every 3 weeks) for two cycles (6 weeks)

Cohort 2: lenvatinib by it self (8 or 12mg PO once daily according to weight

Cohort 3: combination of pembrolizumab and lenvatinib at the standard doses for 6 weeks

Surgery will take place in a 14-day window between day 50 and day 63 from the start of treatment. Between 8-12 weeks following surgery, all patients will begin treatment with pembrolizumab for up to 12 months.

After surgery everyone has to take pembrolizumab.

Key inclusion criteria:

• have a type of liver cancer called hepatocellular carcinoma  
• are able to have surgery to remove the cancer 
• have  at least 1 area of cancer that the doctor can measure on a scan
• are willing to have tissue samples taken
• have a liver that is working normally.
• are able to swallow capsules
• have satisfactory blood test results
• are fully active but might not be able to do heavy physical work (performance status 0 or 1)
• are willing to use contraception during treatment and for a time after if there is any chance you or your partner could become pregnant
• are at least 18 years old
• Low risk of death resulting from surgery surgical morbidity and mortality from liver surgery as defined by the following criteria:

               -   Single tumour

               -  Vascular resection not needed.

               -  Expected remaining residual liver volume 40%

                Non-cirrhotic (No scarring of the liver)

                                  o   Single tumour any size

                 Cirrhotic (scarring of the liver)

                                  o   Major surgery to take out part of the organ (up to 5 segments) only with good liver function as defined locally by:

                                  o   Normal Bilirubin and

                                  o   No enlarged veins that that may be found in the oesophagus in people with cirrhosis of the liver on pre-operative CT