Real-World Outcomes of Atezolizumab–Bevacizumab in Hepatocellular Carcinoma: The Prospective French CHIEF Cohort

Abstract

Background and Aims

Atezolizumab–Bevacizumab (AtezoBev) was the first immunotherapy approved for hepatocellular carcinoma (HCC) in France, with initial trials primarily involving patients with viral-related liver disease. This prospective study aimed to evaluate the efficacy of AtezoBev in a French HCC population predominantly affected by non-viral liver disease.

Methods

Data from 545 HCC patients treated with AtezoBev as first-line systemic therapy were collected from 32 French centres in the CHIEF cohort between July 2020 and January 2023. Kaplan–Meier analysis evaluated overall survival (OS) and progression-free survival (PFS), while log-rank tests assessed the impact of baseline characteristics.

Results

Median age was 69, with 81% Child-Pugh A and 19% Child-Pugh B. Liver disease was primarily alcohol-related (30%) or viral (16%), with mixed aetiology with at least alcohol consumption in 58%. At AtezoBev initiation, 72% of cases were treatment-naive, 31% were BCLC-B and 64% were BCLC-C. Median OS was 23.1 months, with a 12-month survival rate of 66%. OS was higher in BCLC-B patients (27.8 months) compared to BCLC-C (17.2 months, p = 0.0043) and in Child-Pugh A (26.4 months) compared to Child-Pugh B (10.6 months, p < 0.001). Median PFS was 5.2 months, with BCLC-B patients showing significantly longer PFS (6.7 months vs. 3.7 months for BCLC-C, p = 0.05).

Conclusion

Real-world data from the CHIEF cohort demonstrate AtezoBev's effectiveness in a large French HCC population, showing survival and response rates comparable to the IMbrave150 study. These findings validate AtezoBev as effective in routine practice across diverse clinical profiles.