Hepatocellular carcinoma (HCC) is a common cancer globally and a leading cause of cancer-related deaths. Although early-stage disease may be curable by resection, liver transplantation or ablation, many patients present with unresectable disease and have a poor prognosis. Combination treatment with atezolizumab (targeting PD-L1) and bevacizumab (targeting VEGF) in the recent IMbrave150 study was shown to be effective with an acceptable safety profile in patients with unresectable HCC. Herein, we discuss this novel combination in the context of the liver immune environment, summarize the mechanism and pharmacokinetics of atezolizumab and bevacizumab, and examine recent data on other immune checkpoint inhibitor combination strategies as well as future directions in the treatment of patients with advanced HCC.
Keywords: PD-L1; VEGF; atezolizumab; bevacizumab; dual blockade; hepatocellular carcinoma; immune checkpoint inhibitor; tumor immune microenvironment.
Lay abstract Cancer of the liver is common worldwide and is one of the main causes of death from cancer. If caught early, liver cancer can be treated successfully, but most patients are diagnosed when their cancer has already spread and are less likely to survive. A new treatment method using two kinds of antibodies, atezolizumab and bevacizumab, has recently been shown in a clinical trial to be safe and to have a good effect in patients with advanced liver cancer. In this review, we look at how this new treatment works and discuss the results of other clinical trials using similar treatments. We also look ahead to how patients with advanced liver cancer might be treated in the future.