Atezolizumab and bevacizumab in resected or ablated high-risk hepatocellular carcinoma

Results of the IMbrave050 trial, recently published on The Lancet, showed that atezolizumab and bevacizumab is better than active surveillance in improving recurrence-free survival in patients who remain at high risk for hepatocellular carcinoma recurrence after curative-intent resection or ablation.
Recurrence rates within 5 years following liver resection or local ablation in patients with hepatocellular carcinoma have been reported to exceed 70%, but there’s no globally recognised standard of care for adjuvant therapy after these potentially curative treatments. Atezolizumab plus bevacizumab is the standard of care for first-line treatment of unresectable hepatocellular carcinoma, thus the IMbrave 050 trial aimed to compare this combination with active surveillance. This open-label, phase 3 muticenter study recruited 668 patients randomly assigned to either atezolizumab plus bevacizumab (1200 mg atezolizumab plus 15 mg/kg bevacizumab every 3 weeks for 17 cycles) or to active surveillance. At a median duration of follow-up of 17.4 months, adjuvant atezolizumab plus bevacizumab was associated with significantly improved recurrence-free survival compared with active surveillance. «To our knowledge, IMbrave050 is the first phase 3 study of adjuvant treatment for hepatocellular carcinoma to report positive results», authors say. «The results of IMbrave050 indicate that dual inhibition of programmed death-ligand 1 and vascular endothelial growth factor signalling, compared with active surveillance, significantly improves recurrence-free survival in patients at high risk of recurrence following either liver resection or thermal ablation. These results could be a practice-changing adjuvant treatment option for patients with hepatocellular carcinoma at high risk of recurrence and could lead to new considerations in indications for surgical resection. However, longer follow-up for both recurrence-free and overall survival is needed to assess the benefit–risk profile more fully».