IMbrave150

IMbrave150, trial NCT03434379 sponsored by Roche and reported in 2020, ended the sorafenib era by making atezolizumab plus bevacizumab the new first-line standard for unresectable hepatocellular carcinoma. It randomised 501 patients and met both primary endpoints of overall and progression-free survival, with a much higher response rate, becoming the first regimen to beat sorafenib on survival, though bevacizumab's bleeding risk means patients need endoscopy for varices first. OnCo links it to PD-L1 and VEGF as targets, atezolizumab, Richard S. Finn, Ann-Lii Cheng and Ho Yeong Lim, and to the caution pairing about bevacizumab with untreated varices; the result is consistent with the class effect seen in CARES-310 and ORIENT-32. Whether it remains the preferred first-line regimen against dual checkpoint blockade from HIMALAYA and CheckMate 9DW is the open question.