# IMbrave150: atezolizumab plus bevacizumab replaces sorafenib as first treatment for advanced liver cancer

Source: https://onco.cc/key-papers/paper-imbrave150-nejm-2020/  
OnCo record `paper-imbrave150-nejm-2020` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Combining the immunotherapy atezolizumab with the anti-blood-vessel antibody bevacizumab helped patients with advanced hepatocellular carcinoma live longer than sorafenib, ending a decade in which nothing had beaten that drug.

## Summary

Open-label phase 3 trial of 501 patients with unresectable hepatocellular carcinoma and preserved liver function (Child-Pugh A) who had not received systemic therapy, randomised 2:1 to atezolizumab plus bevacizumab or sorafenib. Co-primary endpoints were OS and PFS.

12-month OS was 67.2% vs 54.6% (HR 0.58) and median PFS 6.8 vs 4.3 months (HR 0.59). The updated analysis showed median OS 19.2 vs 13.4 months (HR 0.66). It made atezolizumab plus bevacizumab the first-line standard, showed that immunotherapy combinations can work in liver cancer despite the failure of single-agent checkpoint inhibitors, and set the template for durvalumab plus tremelimumab (HIMALAYA).

## Fields

- Kind: Key paper
- Last checked: 2026-09-08
- Journal: New England Journal of Medicine
- Year: 2020
- DOI: 10.1056/NEJMoa1915745
- Authors: Finn RS, Qin S, Ikeda M, et al.
- Findings: 12-month overall survival 67.2% vs 54.6%; HR 0.58 (95% CI 0.42-0.79).; Median PFS 6.8 vs 4.3 months; HR 0.59.; Objective response 27.3% vs 11.9% (RECIST 1.1).; Updated analysis (2022): median OS 19.2 vs 13.4 months, HR 0.66; median PFS 6.9 vs 4.3 months.; Grade 3-4 adverse events similar (57% vs 55%); upper gastrointestinal bleeding with bevacizumab required endoscopic screening for varices within six months before enrolment.; Patient-reported quality of life deteriorated later with the combination (11.2 vs 3.6 months).
- What it means: Patients with advanced liver cancer and good liver function should be offered atezolizumab plus bevacizumab (or durvalumab plus tremelimumab) rather than sorafenib as first treatment; median survival is now around 19 months and about a quarter of patients respond. Endoscopy to treat varices before starting bevacizumab is essential because of bleeding risk. Patients with poorer liver function (Child-Pugh B) or autoimmune disease or transplants were not studied.
- Caveats: Excluded Child-Pugh B, untreated varices, and prior transplant, so applies to a selected population.; Open-label; sorafenib is now a weak comparator.; Non-viral (metabolic) liver cancer appeared to benefit less in exploratory analyses across several immunotherapy trials.; Bleeding and hypertension from bevacizumab, and cost, remain barriers in high-incidence low-income regions.

## Sources

- NEJM 2020: https://doi.org/10.1056/NEJMoa1915745
- ClinicalTrials.gov NCT03434379: https://clinicaltrials.gov/study/NCT03434379

## Connected records

- cancers: [Advanced hepatocellular carcinoma (BCLC C)](https://onco.cc/cancers/hcc-advanced/), [Hepatocellular carcinoma](https://onco.cc/cancers/hcc/)
- technologies: [Anti-angiogenic therapy](https://onco.cc/technologies/antiangiogenic/), [Immune checkpoint inhibitors](https://onco.cc/technologies/checkpoint-inhibitor/), [Monoclonal antibodies](https://onco.cc/technologies/monoclonal-antibody/)
- targets: [PD-L1](https://onco.cc/targets/pdl1/), [VEGF / VEGFR](https://onco.cc/targets/vegf/)
- drugs: [Atezolizumab](https://onco.cc/drugs/atezolizumab/)
- companies: [Roche / Genentech](https://onco.cc/companies/roche-genentech/)
- terms: [Lines of therapy](https://onco.cc/terms/first-line/), [Overall survival (OS)](https://onco.cc/terms/os/), [Progression-free survival (PFS)](https://onco.cc/terms/pfs/), [Standard of care](https://onco.cc/terms/standard-of-care/)
- people: [Ann-Lii Cheng](https://onco.cc/people/ann-lii-cheng/), [Ho Yeong Lim](https://onco.cc/people/lim-ho-yeong/), [Richard S. Finn](https://onco.cc/people/richard-finn/), [Tae-You Kim](https://onco.cc/people/kim-tae-you/)
- bottlenecks: [Most of the world has almost no cancer care](https://onco.cc/bottlenecks/b-global-access/), [No one can predict who responds to immunotherapy](https://onco.cc/bottlenecks/b-immunotherapy-response/), [Too many combinations to test](https://onco.cc/bottlenecks/b-combination-space/)
- journals: [New England Journal of Medicine](https://onco.cc/journals/nejm/)
- ideas: [Immunotherapy downstaging to transplant with a safe washout](https://onco.cc/ideas/idea-hcc-io-before-transplant/)

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