Retrospective study of atezolizumab-bevacizumab versus locoregional therapy for aHCC with macroscopic vascular invasion

Options for hepatocellular carcinoma (HCC) with macrovascular invasion (MCI) are either systemic immunotherapy or locoregional therapy. A retrospective cohort study at Asan Medical Center (Seoul, South Korea) investigated real-world outcomes with atezolizumab plus bevacizumab versus locoregional therapy (TACE with or without RT) as first-line treatment for patients with HCC and MVI, Child-Pugh A/B, and ECOG performance status 0 or 1. Primary outcomes were overall survival and progression-free survival. The study included 475 patients (atezolizumab-bevacizumab, n=191; locoregional therapy, n=284). Baseline characteristics were similar. Median OS was 9.3 months with atezolizumab-bevacizumab and 10.8 months with locoregional therapy; after inverse probability of treatment weighting, OS remained comparable (HR 0.95; p=0.635). Median PFS was 6.0 months versus 4.1 months favoring atezolizumab-bevacizumab; this persisted after IPTW (HR 0.64; p<0.001). Objective response rates were similar (45% versus 48%; p=0.49). Major adverse events occurred in 11% of patients in both groups. Subgroup analyses showed no OS differences and a consistent PFS advantage with atezolizumab-bevacizumab. The authors conclude that in HCC with MVI, first-line atezolizumab-bevacizumab achieved longer PFS than locoregional therapy, with comparable OS and safety.