Dr Goff on the Investigation of Adjuvant Atezolizumab Plus Bevacizumab in HCC

Laura Goff, MD, associate professor of Medicine, Hematology/Oncology, executive medical director, Vanderbilt-Ingram Cancer Center Patient Care Center, co-chair, Data and Safety Monitoring Committee, Vanderbilt-Ingram Cancer Center, discusses the investigation of adjuvant atezolizumab (Tecentriq) plus bevacizumab (Avastin) in hepatocellular carcinoma (HCC).

The phase 3 IMBrave050 trial (NCT04102098) evaluated the combination of atezolizumab and bevacizumab vs active surveillance following surgery in patients with HCC who were at a high risk for recurrence. Data from a prespecified interim analysis presented at the 2023 AACR Annual Meeting showed that the combination demonstrated a statistically significant and clinically meaningful improvement in recurrence-free survival (RFS) vs active surveillance, meeting the primary end point of the trial. At a median follow-up of 17.4 months, the median RFS, as assessed by independent review facility, was not yet evaluable (NE) with the doublet (n = 334; 95% CI, 22.1–not reached [NR]) or with active surveillance (n = 334; 95% CI, 21.4-NR), but data favored the combination regimen (HR, 0.72; 95% CI, 0.56-0.93; P = .012).

However, data have not demonstrated an overall survival (OS) benefit for atezolizumab and bevacizumab vs active surveillance. Goff notes that this could be attributed to a number of reasons, including immature data. However, because an OS benefit has not been observed, it is possible that a RFS benefit without an OS benefit may mean that the combination is only delaying relapse, and patients are not being cured, Goff explains. If this is the case, administering the combination in the adjuvant setting may not the best option for patients due to the added toxicity associated with this treatment, she says. More information is likely needed to determine which subgroups of patients could derive benefit from treatment with the combination in the adjuvant setting, Goff notes

Goff concludes that she has not started using the combination of atezolizumab and bevacizumab in the adjuvant setting for patients with resected HCC within her practice, and she is waiting to see more mature OS data before considering this option.