Phase 3 trial of liver resection versus maintenance therapy after atezolizumab-bevacizumab induction for locally advanced HCC

Resection might offer additional benefit in patients with advanced-stage hepatocellular carcinoma (HCC) treated with systemic therapy. The phase 3 TALENTOP trial, at 24 centers in China, enrolled 489 treatment-naïve patients with HCC, macrovascular invasion, and no extrahepatic metastasis. Patients received induction therapy with atezolizumab and bevacizumab. Patients who had a partial response or stable disease after the induction phase, and were considered feasible for resection, were randomized 1:1 to undergo surgical resection followed by 12 months of atezolizumab plus bevacizumab (surgery group; n=101) or maintenance atezolizumab plus bevacizumab until loss of clinical benefit or intolerable toxicity (maintenance therapy group; n=100). Primary endpoint was time to treatment failure (TTF) from randomization, assessed by an independent review facility. Median follow-up was 18.4 months. Median TTF was 20.4 months in the surgery group and 11.8 months in the maintenance therapy group (HR 0.60; p=0.015). Grade 3 or 4 treatment-related adverse events occurred in 39% of patients in the surgery group and 21% of patients in the maintenance therapy group. Two treatment-related deaths occurred in the surgery group. The authors conclude that in patients with advanced HCC with macrovascular invasion after systemic therapy, TTF was longer among those who had liver resection than among those who received maintenance therapy.