IMbrave050: the first step towards adjuvant therapy in hepatocellular carcinoma

Immuno-oncology based regimens have become the standard of care in the palliative systemic therapy of hepatocellular carcinoma, and their efficacy in earlier stages—including the neoadjuvant and adjuvant setting—is under active investigation. 1 Vogel A Meyer T Sapisochin G Salem R Saborowski A Hepatocellular carcinoma. Lancet. 2022; 400: 1345-1362 Summary Full Text Full Text PDF PubMed Scopus (261) Google Scholar Following negative results for adjuvant sorafenib in the global STORM trial in 2015 that did not show an improvement of recurrence-free survival compared with placebo, 2 Bruix J Takayama T Mazzaferro V et al. Adjuvant sorafenib for hepatocellular carcinoma after resection or ablation (STORM): a phase 3, randomised, double-blind, placebo-controlled trial. Lancet Oncol. 2015; 16: 1344-1354 Summary Full Text Full Text PDF PubMed Scopus (705) Google Scholar the adjuvant field remained open for several years, until four global phase 3 trials in parallel began investigating immuno-onocology concepts following curative-intent resection or ablation. In The Lancet, Shukui Qin and colleagues reported the results of their first interim analysis of the IMbrave050 trial, 3 Qin S Chen M Cheng A-L et al. Atezolizumab plus bevacizumab versus active surveillance in patients with resected or ablated high-risk hepatocellular carcinoma (IMbrave050): a randomised, open-label, multicentre, phase 3 trial. Lancet. 2023; (published online Oct 20.)https://doi.org/10.1016/S0140-6736(23)01796-8 Summary Full Text Full Text PDF Scopus (3) Google Scholar comparing atezolizumab in combination with bevacizumab, an anti-programmed death-ligand 1 and an anti–vascular endothelial growth factor, versus active surveillance after curative-intent resection or ablation in hepatocellular carcinoma, and reporting positive recurrence-free survival (RFS), becoming the first trial to do so. Atezolizumab plus bevacizumab versus active surveillance in patients with resected or ablated high-risk hepatocellular carcinoma (IMbrave050): a randomised, open-label, multicentre, phase 3 trialAmong patients at high risk of hepatocellular carcinoma recurrence following curative-intent resection or ablation, recurrence-free survival was improved in those who received atezolizumab plus bevacizumab versus active surveillance. To our knowledge, IMbrave050 is the first phase 3 study of adjuvant treatment for hepatocellular carcinoma to report positive results. However, longer follow-up for both recurrence-free and overall survival is needed to assess the benefit–risk profile more fully. Full-Text PDF