On the double.

Top Line: Sorafenib is the preferred first-line systemic therapy option for advanced, unresectable hepatocellular carcinoma (HCC).

The Study: In IMbrave150, the standard second-line option of atezolizumab + bevacizumab was compared to sorafenib in the first-line setting for patients not eligible for curative or locoregional therapy and with Child-Pugh A liver function and no gastric or esophageal varices. Over 500 patients were randomized in a 2:1 fashion, and the atezo+bev combo significantly improved overall survival at 6 months from 72 → 85% and at 12 months from 55 → 67%. Median progression free survival was also improved from 4 → 7 months. The response rate with atezo+bev (27%) was more than double that of sorafenib (12%), and the duration of response was much longer with 88% of atezo+bev responses lasting > 6 months compared to 59% for sorafenib. Despite an increased rate of serious adverse events, the improvement in disease outcomes with atezo+bev also led to a higher rate of quality of life preservation making for a first-time win for immune checkpoint inhibition for HCC.

TBL: First-line atezolizumab and bevacizumab results in superior survival and disease outcomes compared to sorafenib for advanced, unresectable HCC in patients with preserved liver function. | Finn, N Engl J Med 2020