Three-year overall survival in unresectable hepatocellular carcinoma treated with atezolizumab plus bevacizumab.

Background: Hepatocellular carcinoma (HCC) remains a leading cause of cancer-related mortality. Although the atezolizumab/bevacizumab regimen demonstrated impressive efficacy in the IMbrave150 clinical trial, long-term outcomes, particularly 3-year overall survival (OS), remain unestablished because of limited follow-up. Long-term outcomes have been reported for the tremelimumab/durvalumab combination, highlighting the need for comparable data on atezolizumab/bevacizumab. We aimed to elucidate the 3-year OS in patients with unresectable HCC (uHCC) treated with atezolizumab plus bevacizumab.

Methods: This retrospective multicenter study included patients with uHCC who received atezolizumab/bevacizumab. Among the 506 patients treated at the participating institutions, only those who initiated therapy between October 2020 and January 2022 were included. Comprehensive clinical, laboratory, and imaging data were collected, and the patients were followed up until March 2025.

Results: A total of 257 patients were analyzed, with a median follow-up of 48.23 months (range, 36.23-53.60 months). The 2- and 3-year OS rates were 39.2% and 25.3%, respectively. Among patients meeting the IMbrave150 criteria, the 3-year OS rate was 31.6%. Multivariate regression analysis identified baseline alpha-fetoprotein level > 116 ng/mL (odds ratio [OR] 0.41; 95% confidence interval [CI] 0.20-0.84; p = 0.015) and modified albumin-bilirubin grade 1-2a (OR 2.50; 95% CI 1.18-5.32; p = 0.017) as significant factors associated with 3-year OS.

Conclusions: In a real-world setting, the 3-year OS for uHCC patients treated with atezolizumab/bevacizumab was 25.3%, rising to 31.6% among those meeting the IMbrave150 criteria. Survival outcomes underscore the clinical value of atezolizumab/bevacizumab in improving long-term prognosis and guiding first-line treatment decisions for patients with unresectable HCC.