Dr. Pishvaian on FDA Approval of Atezolizumab Plus Bevacizumab in HCC

Michael J. Pishvaian, MD, PhD, a gastrointestinal oncologist and head of the Phase I Program at the Georgetown Lombardi Comprehensive Cancer Center, discusses the FDA approval of the combination of atezolizumab (Tecentriq) and bevacizumab (Avastin) for the treatment of patients with hepatocellular carcinoma (HCC).

The combination of the PD-L1 inhibitor and anti-VEGF agent was approved by the FDA on May 29, 2020 for the treatment of patients with unresectable or metastatic HCC who have not received prior systemic therapy. The approval is based on findings from the phase 3 IMbrave150 study, which demonstrated that atezolizumab plus bevacizumab led to a 42% reduction in the risk of death compared with sorafenib (Nexavar; HR, 0.58; 95% CI, 0.42-0.79; P = .0006). The combination was also associated with a 41% reduction in the risk of disease progression or death versus sorafenib (HR, 0.59; 95% CI, 0.47-0.76; P <.0001).

This combination has been shown to improve outcomes for patients with advanced HCC, demonstrating very durable responses, Pishvaian says. Some patients are achieving complete responses, allowing them to return to a normal quality of life.

Multikinase inhibitors were the traditional therapies used in this space, but although these drugs were effective, they came with notable toxicities. While immunotherapy agents bring along their own unique set of adverse events, this combination has been generally well tolerated in the vast majority of patients.