image: IMbrave150 abstract table
Singapore, 23 November 2019 - Combination therapy with the PD-L1 inhibitor atezolizumab and the VEGF inhibitor bevacizumab significantly improves overall survival and progression-free survival in patients with unresectable hepatocellular carcinoma (HCC) compared to standard of care, showed results from a phase 3 study reported at the ESMO Asia 2019 Congress. (1,2)
"This is the first study in 11 years to show an improvement in survival with a new fist-line treatment option compared to sorafenib, which has been the standard of care throughout this time," said study first author Ann-Lii Cheng, Director of the National Taiwan University Cancer Center, Taipei, Taiwan. He added, "Atezolizumab plus bevacizumab has the potential to be a practice-changing treatment option in hepatocellular carcinoma."
Unresectable HCC is currently a major challenge in countries with a high prevalence of this cancer. Most patients in countries without screening programmes present with unresectable or advanced HCC because of the late appearance of symptoms, resulting in a very high mortality rate (almost 80%).
"Despite many studies over the past 11 years, we have been unable to find any better treatment option. This has been very frustrating because sorafenib has a response rate of around 10% and is associated with severe side-effects," he explained.
The phase 3 IMbrave150 study randomised patients with unresectable HCC to a combination of atezolizumab plus bevacizumab or sorafenib. Atezolizumab reactivates the immune response to tumour cells while bevacizumab stops tumours growing new blood vessels to obtain nutrients and oxygen but also helps upregulate host immunity to fight against cancer.
Results showed statistically and clinically meaningful improvement in the co-primary endpoints of overall survival and progression-free survival in patients treated with atezolizumab plus bevacizumab compared to those treated with sorafenib.
Commenting on the findings, Ian Chau, Consultant Medical Oncologist at the Royal Marsden Hospital, London, UK, said: "This is the first time a novel treatment has shown a survival benefit compared to the current standard of care. The results are very encouraging and there is a strong possibility this drug combination will be approved by regulatory authorities and be incorporated into international guidelines for advanced HCC."
Angela Lamarca, Consultant Medical Oncologist at the Christie NHS Foundation Trust, Manchester, UK, agreed: "I think this is a breakthrough and based on the results, the combination of atezolizumab plus bevacizumab could become the new standard of care."
Lamarca added, "The results are clinically meaningful in the setting of advanced HCC, as well as statistically significant. The delayed deterioration in quality of life is also important - patients are living longer and their quality of life is better."
She considered the study was well-designed, with several strengths including its large sample size, with just over 500 patients, the use of a combination endpoint of PFS and OS, assessment of response/progression by a central reviewer and analysis based on the intention-to-treat population.
Lamarca also noted that the median follow-up of 8.6 months is relatively short, with the median OS for atezolizumab plus bevacizumab not yet reached. Chau agreed, noting that the improvement in OS is currently based on relatively immature data, with longer follow-up needed to confirm the magnitude of the OS benefit.
Looking to the future, Chau said, "The combination of atezolizumab plus bevacizumab will be very useful to patients with advanced HCC as a new systemic therapy but, with the high cost of immunotherapy and anti-angiogenic agents, it will also be important that those drugs are accessible to patients."
Study results
The phase 3 IMbrave150 study randomised 501 patients with unresectable HCC on a 2:1 basis to atezolizumab (1200mg IV every three weeks) plus bevacizumab (15mg/kg IV every three weeks) or sorafenib (400mg twice daily). The patients continued with their assigned treatment until unacceptable toxicity or loss of clinical benefit as judged by study investigators.
Results showed the hazard ratio (HR) for overall survival (OS) was 0.58 (95% CI 0.42, 0.79, p=0.0006) after a median follow-up of 8.6 months. The median OS had not yet been reached for atezolizumab plus bevacizumab compared to 13.2 months for patients randomised to sorafenib. Median progression free survival (PFS) was also significantly increased (median 6.8 vs 4.3 months, HR 0.59, 95% CI 0.47, 0.76, p
Overall response rate was more than twice as high with atezolizumab plus bevacizumab compared to sorafenib (27% vs 12%, p
Grade 3-4 adverse events occurred in 57% of patients treated with Atezolizumab plus bevacizumab and 55% of those receiving sorafenib. Grade 5 adverse events occurred in 5% and 6% of patients, respectively.
Notes to Editors
Please make sure to use the official name of the meeting in your reports: ESMO Asia 2019 Congress
Official Congress Hashtag: #ESMOAsia19
References
1 Abstract LBA3 'IMbrave150: Efficacy and safety results from a ph III study evaluating atezolizumab (atezo) + bevacizumab (bev) vs sorafenib (Sor) as first treatment (tx) for patients (pts) with unresectable hepatocellular carcinoma (HCC)' will be presented by Ann-Lii Cheng during the Presidential Symposium on Saturday, 23 November 2019, 11:00-12:30 (SGT) in Hall 406. Annals of Oncology, Volume 30, 2019 Supplement 9
2 ESMO Asia Congress 2019 https://www.esmo.org/Conferences/ESMO-Asia-Congress-2019
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LBA3 - IMbrave150: Efficacy and safety results from a ph III study evaluating atezolizumab (atezo) + bevacizumab (bev) vs sorafenib (Sor) as first treatment (tx) for patients (pts) with unresectable hepatocellular carcinoma (HCC)
A-L. Cheng1, S. Qin2, M. Ikeda3, P. Galle4, M. Ducreux5, A. Zhu6, T-Y. Kim7, M. Kudo8, V. Breder9, P. Merle10, A. Kaseb11, D. Li12, W. Verret13, Z. Xu14, S. Hernandez15, J. Liu16, C. Huang17, S. Mulla18, H.Y. Lim19, R. Finn20
1Department of Oncology, National Taiwan University Cancer Center and National Taiwan University Hospital, Taipei, Taiwan, 2Cancer Center, People's Liberation Army Cancer Center, Nanjing, China,
3Hepatobiliary & Pancreatic On-cology Dept., National Cancer Center Hospital East, Kashiwa, Japan, 4I. Medical Department, University Medical Cen-ter Mainz, Mainz, Germany, 5Medical Oncology, Gustave Roussy Cancer Center, Villejuif, France, 6Cancer Center, Harvard Medical School, Massachusetts General Hospital Cancer Center, Boston, MA, USA, 7Medical Oncology Cen-ter, Seoul National University College of Medicine, Seoul, Republic of Korea, 8Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan, 9Chemotherapy Dept No17, N.N. Blokhin Russian Cancer Research Center, Moscow, Russian Federation, 10Hepatology and Gastroenterology Unit, Hopital de la Croix-
Rousse, Lyon, France, 11GI Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA, 12Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA, USA, 13Product Development - Oncology, Genentech, Inc., San Francisco,
CA, USA, 14Product Development, Roche, Beijing, China, 15Product Development Oncology Department, Genentech, Inc. - Member of the Roche Group, South San Francisco, CA, USA, 16Product Development, Shanghai Roche Pharma-ceuticals Ltd., Shanghai, China, 17Safety Science Oncology, Roche Product Development, Shanghai, China, 18Product Development, F. Hoffmann-La Roche, Ltd., Mississauga, ON, Canada, 19Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea, 20Jonsson Comprehensive Cancer Center, Geffen School of Medicine at UCLA, Los Angeles, CA, USA
Introduction: Ph 1b data has shown promising efficacy and safety for atezo + bev in unresectable HCC pts who have not received prior systemic therapy. Here, we report the primary analysis data from the Ph 3 IMbrave150 trial comparing atezo + bev vs sor in this pt population.
Methods: IMbrave150 enrolled systemic treatment (tx)-naïve pts with unresectable HCC. Pts were randomised 2:1 to receive either atezo 1200 mg IV q3w + bev 15 mg/kg IV q3w or sor 400 mg BID until unacceptable toxicity or loss of clinical benefit per investigator. Coprimary endpoints were OS and PFS by independent review facility (IRF)-assessed RECIST 1.1. The key secondary endpoints IRF-ORR per RECIST 1.1 and IRF-ORR per HCC mRECIST were also part of the study statistical testing hierarchy.
Results: The ITT population included 336 pts randomised to atezo + bev and 165 randomised to sor. Baseline de-mographics were well balanced between arms. With a median follow up of 8.6 mo, OS HR was 0.58 (95% CI, 0.42, 0.79; P = 0.0006) and PFS HR was 0.59 (95% CI, 0.47, 0.76; P
Conclusions: IMbrave150 demonstrated statistically significant and clinically meaningful improvement in both OS and PFS for atezo + bev vs sor in pts with unresectable HCC who have not received prior systemic therapy. The safety of atezo + bev is consistent with the known safety profile of each agent, and no new safety signals were identified. Ate-zo + bev has the potential to be a practice changing tx in HCC.