Atezolizumab plus Bevacizumab vs Sorafenib or Atezolizumab Alone for Unresectable Hepatocellular Carcinoma: Systematic Review

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Abstract


BACKGROUND

Despite the use of the current standard therapy, the prognosis of unresectable hepatocellular carcinoma (HCC) patients is poor, with median survival times of 40 mo in intermediate HCC [Barcelona Clinic Liver Cancer (BCLC) stage B] and 6–8 mo in advanced HCC (BCLC stage C). Although patients with early-stage HCC are usually suitable for therapies with curative intention, up to 70% of patients may manifest disease relapses at 5-year surveillance. Within the past decade, there have been many Food and Drug Administration-approved immunogenic treatment options for advanced HCC, the most common type of liver cancer among adults. Nevertheless, no treatment has been demonstrated to be useful in the adjuvant setting. Since 2007 the multi-kinase inhibitor, sorafenib has been the first-line targeted drug to address the increased mortality to incidence ratio of HCC. However, in 2020 the IMbrave150 trial demonstrated that the combination therapy of atezolizumab [anti-programmed death-ligand 1 (PD-L1)] and bevacizumab (anti-VEGF) proved to be superior to the sorafenib, a single anti-programmed death 1/PD-L1 antibody inhibitor used in anticancer monotherapy for HCC treatment.

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