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IMbrave150 Supports Atezolizumab Plus Bevacizumab For Inoperable HCC

Patients with unresectable hepatocellular carcinoma have better survival with the combination of atezolizumab and bevacizumab than with sorafenib
28 Nov 2019
Anticancer Agents;  Gastrointestinal Cancers;  Hepatobiliary Cancers;  Immunotherapy;  Therapy

Author:  By Lynda Williams, Senior medwireNews Reporter

medwireNews: Use of atezolizumab plus bevacizumab has extended overall survival (OS) for patients with locally advanced or metastatic hepatocellular carcinoma (HCC) unsuitable for surgery compared with the standard of care sorafenib in the IMbrave150 trial. 

The study findings were presented at the ESMO Asia Congress 2019 in Singapore by Ann-Lii Cheng, from the National Taiwan University Cancer Center in Taipei, who said that the combination “should be considered a practice-changing treatment for patients with unresectable HCC who have not received prior systemic therapy.” 

The co-primary endpoint of median OS was significantly longer for the 336 patients who received atezolizumab 1200 mg plus bevacizumab 15 mg/kg every 3 weeks than for the 165 patients who instead were given sorafenib 400 mg twice daily, at not estimable versus 13.2 months, with a hazard ratio (HR) for death of 0.58. 

The second co-primary endpoint of progression-free survival (PFS) was also significantly improved with use of atezolizumab–bevacizumab compared with sorafenib, at a median of 6.8 versus 4.3 months and a HR for progression or death of 0.59. 

Six-month OS was achieved by 85% and 72% of the atezolizumab–bevacizumab and sorafenib treatment arms, respectively, while the corresponding 6-month PFS rates were 55% and 37%. 

The secondary endpoint of the objective response rate was significantly higher with the combination than sorafenib whether patients were assessed by an independent review facility using RECIST v 1.1 (27 vs 12%) or by RECIST criteria using measurable disease at baseline (33 vs 13%). 

The median duration of response was not estimable for atezolizumab–bevacizumab and 6.3 months for sorafenib according to both RECIST assessments. 

Median treatment durations were 7.4 months for atezolizumab, 6.9 months for bevacizumab and 2.8 months for sorafenib. 

Patient-reported outcomes using the EORTC QLQ-C30 questionnaire given every 3 weeks during treatment and every 3 months thereafter suggested that atezolizumab-bevacizumab significantly delayed the time to quality of life deterioration, at a median of 11.2 months versus 3.6 months with sorafenib (HR=0.63). 

Treatment-related adverse events (TRAEs) at any grade occurred in 84% of the combination arm and 94% of the sorafenib arm; the corresponding rates of grade 3–4 TRAEs were 36% and 46%, while grade 5 TRAEs occurred in 2% and less than 1% of patients, respectively. 

Of note, sorafenib-treated patients had higher rates of palmar–plantar erythrodysaesthesia, diarrhoea, alopecia, and asthaenia than those given atezolizumab–bevacizumab, although the combination was associated with higher rates of pyrexia, alanine transaminase elevation, proteinuria and infusion-related reactions. 

“The safety and tolerability profile of atezolizumab [plus] bevacizumab was in line with the known safety profiles of each individual component and the underlying disease”, summarised Ann-Lii Cheng. 

 

Reference  

Cheng A-L, Qin S, Ikeda M, et al. Atezolizumab + bevacizumab vs sorafenib in patients with unresectabe hepatocellular carcinoma: Phase 3 results from IMbrave150. Ann Oncol 2019; 30 (suppl_9): ix183-ix202. doi:10.1093/annonc/mdz446

Last update: 28 Nov 2019

medwireNews (www.medwireNews.com) is an independent medical news service provided by Springer Healthcare. © 2019 Springer Healthcare part of the Springer Nature group

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