Atezolizumab plus Bevacizumab in the Treatment of Unresectable HCC

This is a video synopsis/summary of a Post-Conference Perspectives featuring Anwaar Saeed, MD, and Amit Singal, MD, MS.

Singal and Saeed discuss the IMbrave150 study published in 2020, which led to FDA approval of the combination of atezolizumab plus bevacizumab as a first-line treatment for unresectable hepatocellular carcinoma (HCC). This regimen showed superior progression-free and overall survival compared to sorafenib, along with higher response rates. It was also well tolerated, albeit with a requirement for pretreatment upper endoscopy due to the bleeding risk with bevacizumab. Unfortunately, there are no clear predictive biomarkers to select patients most likely to benefit from atezolizumab-bevacizumab.

A recent analysis in the British Journal of Cancer examined changes in alpha fetoprotein (AFP) levels over time as a potential prognostic marker for patients on atezolizumab-bevacizumab. Those with rising AFP trajectories had worse outcomes compared to those with decreasing AFP levels. In practice, Singal finds AFP trends informative but still relies primarily on imaging to determine response and guide treatment decisions. Saeed agrees more validation is needed to define how best to incorporate AFP kinetics into clinical decision-making, both for first-line atezolizumab-bevacizumab as well as for other regimens when determining sequencing strategies. She suggests analyzing AFP data from other trials like HIMALAYA to further explore its potential prognostic utility. Ultimately, having molecular markers and biomarkers beyond just AFP will be crucial to guide therapy selection and sequencing in HCC.

Video synopsis is AI-generated and reviewed by OncLive® editorial staff.