Atezolizumab and bevacizumab for HCC in the real world.

The combination of atezolizumab and bevacizumab (AB) has been a game changer in the first-line treatment of advanced hepatocellular carcinoma (HCC) and is now incorporated into most international guidelines, alongside lenvatinib and sorafenib.1 In the landmark ImBRAVE 150 trial, atezolizumab with bevacizumab improved median overall survival by 9.6 months compared to sorafenib with an HR of 0.58 ( I p i < 0.001).2 In updated results, after a median follow-up of 15.6 months, the median OS with the combination was an impressive 19.2 months, the longest OS we have seen in any phase 3 advanced HCC trial and this was accompanied by an overall response rate of 30%, more than double that of sorafenib.3 More recently, data from the COSMIC-312 trial were presented, providing the combination of atezolizumab and cabozantinib as another potential option for first-line HCC treatment.4 The combination of tremelimumab and durvalumab has also been shown to increase survival over sorafenib in the HIMALAYA trial.5 Further combination therapies being tested in ongoing phase 3 trials will likely provide even more treatment options for this group of patients, making the decision on how to choose or sequence these systemic therapies in advanced HCC more complex. Further real-world studies are needed in different populations to understand the efficacy in patients who may not fit trial criteria.8 With increasing treatment options for advanced HCC, the question of how best to choose becomes more difficult. Phase 3 randomized, open-label, multicenter study of tremelimumab (T) and durvalumab (D) as first-line therapy in patients (pts) with unresectable hepatocellular carcinoma (uHCC): HIMALAYA. [Extracted from the article]