In recent years, significant progress has been made in treating advanced unresectable hepatocellular carcinoma (HCC) through immunotherapy. The IMbrave 150 phase III study investigated the combined therapy of atezolizumab plus bevacizumab, known as atezobev, and demonstrated superior overall and progression-free survival outcomes compared to sorafenib. The study aims to evaluate the effectiveness and safety of atezobev in real-world clinical data.

Researchers conducted a retrospective analysis of the patient records at Sheba Medical Center, focusing on individuals diagnosed with advanced HCC between January 2020 and February 2023. The study population included patients who received atezobev as their initial systemic therapy. Adverse events were documented based on the Common Terminology Criteria for Adverse Events (CTCAE) v5.0, and response evaluation was conducted following the Response Evaluation Criteria In Solid Tumors (RECIST) v1.1.

Researchers identified 37 patients who received atezobev as part of their treatment. The mean age of the study population was 70 years (interquartile range [IQR]: 60-72), and 19% of the patients were female (n=7). The median ECOG performance status was 1 (IQR: 0-1.5), and 35% of patients had non-viral etiology for HCC (n=13), while 65% had viral etiology (HBV/HCV) (n=24). The overall response rate (ORR) was 29.7% (n=11), with stable disease observed in 27.0% (n=10) and progressive disease in 43.2% (n=16) of patients. Comparatively, the ORR reported in the IMbrave 150 study was 27%. There were no significant differences in the response rate based on previous local treatment or HCC etiology. Grade 3/4 adverse events included grade 3 hepatitis (10.8%, n=4), grade 3 diarrhea (2.7%, n=1), and grade 4 infusion-related reaction (2.7%, n=1). The IMbrave 150 study reported grade 3/4 hepatitis, diarrhea, and infusion-related reaction in 7.0%, 1.8%, and 2.4% of patients, respectively.

The efficacy and toxicity profile of atezobev in this cohort of advanced HCC patients treated at a prominent tertiary medical center closely resembled the findings reported in the IMbrave 150 phase III study.