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Background and aims <p>Transarterial chemoembolization (TACE) combined with immunotherapy and targeted therapy provides a promising therapy for unresectable hepatocellular carcinoma (HCC). This study aimed to compare the efficacy and safety of TACE combined with atezolizumab and bevacizumab (TACE–Ate–Bev) or atezolizumab and bevacizumab alone (Ate–Bev) as first-line treatment for unresectable HCC.</p> Methods <p>This multicenter cohort study recruited patients with unresectable HCC who received TACE–Ate–Bev or Ate–Bev as first-line treatment between July 1, 2020 and December 31, 2023. Inverse probability of treatment weighting (IPTW) was employed to minimize bias. Overall survival (OS), progression-free survival (PFS), and adverse events (AEs) were observed.</p> Results <p>311 patients were included in this analysis, with 152 in the TACE–Ate–Bev group and 159 in the Ate–Bev group. The TACE–Ate–Bev group demonstrated significantly improved OS (26.8 [95% CI 23.1–NR] vs. 14.9 [95% CI 11.4–19.9] months, <i>p</i> &lt; 0.0001) and PFS (16.0 [95% CI 12.8–17.8] vs. 6.5 [95% CI 5.4–7.6] months, <i>p</i> &lt; 0.0001) compared to the Ate–Bev group, both in BCLC stage B (mOS: NR vs. 15.6&#xa0;months, <i>p</i> &lt; 0.0001; mPFS: 16.9 vs. 6.7&#xa0;months, <i>p</i> &lt; 0.0001) and BCLC stage C (mOS: 25.2 vs. 14.3&#xa0;months, <i>p</i> = 0.00018; mPFS: 12.8 vs. 6.5&#xa0;months, <i>p</i> &lt; 0.0001) disease. After IPTW adjustment, the TACE–Ate–Bev group also demonstrated significantly improved OS and PFS compared to the Ate–Bev group, both in BCLC stage B and BCLC stage C disease. Grade 3–4 AEs were observed in 36 patients (24.3%) in the TACE–Ate–Bev group and 34 (21.4%) in the Ate–Bev group. There was no statistically significant difference in the proportion of gastrointestinal bleeding between the TACE–Ate–Bev and Ate–Bev groups (9.9 vs. 10.1%, <i>p</i> = 0.954).</p> Conclusion <p>TACE–Ate–Bev significantly improves OS and PFS with acceptable toxicity compared with Ate–Bev as first-line therapy for unresectable HCC.</p> Graphical abstract <p></p>

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Efficacy and safety of atezolizumab and bevacizumab with or without TACE as first-line therapy for unresectable HCC: a multicenter cohort study

  • 期刊论文

  • 发表日期：

    2025年8月25日

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  • Ningning Zhang,
  • Kaipeng Liu,
  • Yuexi Yu,
  • Kai Yuan,
  • Haipeng Yu,
  • Jean Charles Nault,
  • Claudia Campani,
  • Lorraine Blaise,
  • Sara Mouri,
  • Eleonore Spitzer,
  • Yawei Du,
  • Shuwen Zhang,
  • Wenwen Zhu,
  • Hao Yu,
  • Tian Liu,
  • Xuanchen Liu,
  • Ming Luo,
  • Huiru Liu,
  • Yiyan Zhang,
  • Yiming Huo,
  • Feng Duan,
  • Manon Allaire,
  • Wei Lu,
  • Jihui Hao

摘要

Background and aims

Transarterial chemoembolization (TACE) combined with immunotherapy and targeted therapy provides a promising therapy for unresectable hepatocellular carcinoma (HCC). This study aimed to compare the efficacy and safety of TACE combined with atezolizumab and bevacizumab (TACE–Ate–Bev) or atezolizumab and bevacizumab alone (Ate–Bev) as first-line treatment for unresectable HCC.

Methods

This multicenter cohort study recruited patients with unresectable HCC who received TACE–Ate–Bev or Ate–Bev as first-line treatment between July 1, 2020 and December 31, 2023. Inverse probability of treatment weighting (IPTW) was employed to minimize bias. Overall survival (OS), progression-free survival (PFS), and adverse events (AEs) were observed.

Results

311 patients were included in this analysis, with 152 in the TACE–Ate–Bev group and 159 in the Ate–Bev group. The TACE–Ate–Bev group demonstrated significantly improved OS (26.8 [95% CI 23.1–NR] vs. 14.9 [95% CI 11.4–19.9] months, p < 0.0001) and PFS (16.0 [95% CI 12.8–17.8] vs. 6.5 [95% CI 5.4–7.6] months, p < 0.0001) compared to the Ate–Bev group, both in BCLC stage B (mOS: NR vs. 15.6 months, p < 0.0001; mPFS: 16.9 vs. 6.7 months, p < 0.0001) and BCLC stage C (mOS: 25.2 vs. 14.3 months, p = 0.00018; mPFS: 12.8 vs. 6.5 months, p < 0.0001) disease. After IPTW adjustment, the TACE–Ate–Bev group also demonstrated significantly improved OS and PFS compared to the Ate–Bev group, both in BCLC stage B and BCLC stage C disease. Grade 3–4 AEs were observed in 36 patients (24.3%) in the TACE–Ate–Bev group and 34 (21.4%) in the Ate–Bev group. There was no statistically significant difference in the proportion of gastrointestinal bleeding between the TACE–Ate–Bev and Ate–Bev groups (9.9 vs. 10.1%, p = 0.954).

Conclusion

TACE–Ate–Bev significantly improves OS and PFS with acceptable toxicity compared with Ate–Bev as first-line therapy for unresectable HCC.

Graphical abstract