Five years after IMbrave150 with clinical integration of atezolizumab plus bevacizumab in hepatocellular carcinoma - PubMed
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- #locoregional therapy
- #hepatocellular carcinoma
- #atezolizumab-bevacizumab
- Atezolizumab plus bevacizumab (ate/bev) remains the first-line standard for unresectable hepatocellular carcinoma (uHCC) five years after IMbrave150.
- High response rates enable downstaging and curative conversion, sometimes leading to drug-free remission, suggesting potential for treatment de-escalation, but discontinuation criteria need validation.
- In hepatitis B virus-related HCC, ate/bev is safe with antiviral therapy, regardless of baseline viral load.
- Bleeding risks, especially from esophagogastric varices, require baseline endoscopy and proactive management; hypertension and proteinuria need close monitoring to maintain bevacizumab use.
- Late bevacizumab interruption is acceptable, while early discontinuation is linked to poorer outcomes; after progression on ate/bev, tyrosine kinase inhibitors like lenvatinib are preferred over sorafenib, with cabozantinib and ramucirumab as options.
- Combining ate/bev with locoregional therapy (LRT) shows promise, with phase III data supporting transarterial chemoembolization for improved progression-related endpoints, but high-level evidence for other LRTs like Yttrium-90 radioembolization is lacking.
- Translational markers, such as pre-existing immunity, are promising but unvalidated; adjuvant ate/bev has not shown durable benefit, and neoadjuvant roles require further exploration.
- Key gaps include biomarkers for regimen selection, de-escalation criteria, optimal sequencing, and integration with LRT or perioperative care, necessitating prospective studies.