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Atezolizumab plus Bevacizumab with or without Transarterial Chemoembolization as First-Line Treatment for Barcelona Clinic Liver Cancer Stage C Hepatocellular Carcinoma: A Nationwide Multicenter Retrospective Study

Year: 2026

Type: article

Abstract: Background: Atezolizumab plus bevacizumab (TA) has been recommended globally for patients with Barcelona Clinic Liver Cancer (BCLC) stage C hepatocellular carcinoma (HCC); however, this regimen has shown modest survival benefits. Therefore, this study aimed to assess the efficacy and safety of TA with or without transarterial chemoembolization (TACE) as first-line treatment for BCLC C HCC.Methods: This nationwide multicenter retrospective cohort study recruited patients with BCLC stage C HCC from 14 medical centers who received TACE combined with TA (TACE+TA) or TA alone as first-line treatment between October 2020 and January 2025. To mitigate potential confounding imbalances between groups, propensity score matching (PSM) and stabilized inverse probability of treatment weighting (sIPTW) were applied. Overall survival (OS) was set as the primary endpoint, with progression-free survival (PFS), objective response rate (ORR), and safety assessed as the secondary endpoints.Findings: Of the 256 patients included in the analysis, 154 received TACE+TA and 102 received TA. After PSM, analysis of 84 patients per group showed that the TACE+TA group significantly extended the median OS (26.0 months vs. 15.5 months, P < 0.001) and PFS (14.3 months vs. 9.2 months, P = 0.001), compared with the TA group. Post-application of sIPTW, 154 patients were assigned to the TACE+TA group and 101 to the TA group, and the median OS (25.9 vs. 15.4 months, P < 0.001) and PFS (15.5 vs. 7.5 months, P < 0.001) were significantly longer in the TACE+TA group than in the TA group. A higher ORR was observed in the TACE+TA group compared with the TA group (primary cohort: 48.7% vs. 31.4%, P = 0.009; PSM cohort: 47.6% vs. 29.8%, P = 0.027; sIPTW cohort: 50.1% vs. 32.1%, P = 0.006). Moreover, Grade 3/4 adverse events (AEs) occurred in 60 patients (39.0%) in the TACE+TA group and 34 patients (33.3%) in the TA group.Interpretation: Compared with TA alone, TACE+TA may significantly improve ORR, PFS, and OS as first-line treatment for BCLC stage C HCC, while maintaining an acceptable safety profile.

Source: Liver Cancer

DOI: 10.1159/lic/admag010