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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.
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).
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.
Shares Ho Yeong Lim, Ann-Lii Cheng, Richard S. Finn, Immunotherapy downstaging to transplant with a safe washout.
Shares Immunotherapy downstaging to transplant with a safe washout, Advanced hepatocellular carcinoma (BCLC C), Atezolizumab, Roche / Genentech.
Shares Ann-Lii Cheng, Immunotherapy downstaging to transplant with a safe washout, Atezolizumab, Roche / Genentech.
Shares Advanced hepatocellular carcinoma (BCLC C), Atezolizumab, Roche / Genentech, Anti-angiogenic therapy.
Shares Immunotherapy downstaging to transplant with a safe washout, Advanced hepatocellular carcinoma (BCLC C), Atezolizumab, Anti-angiogenic therapy.
Shares Lines of therapy, Too many combinations to test, Progression-free survival (PFS), Overall survival (OS).
Shares Atezolizumab, Roche / Genentech, Anti-angiogenic therapy, Monoclonal antibodies.
Shares Lines of therapy, Too many combinations to test, Progression-free survival (PFS), Overall survival (OS).