IMbrave150: What the Liver Cancer Trial Found

Breaking a deadlock that had lasted twelve years

Sorafenib was approved for advanced liver cancer in 2007. For the next twelve years, nothing beat it. Trial after trial tried and failed. IMbrave150 was the one that finally succeeded, by pairing an immune drug, atezolizumab, with bevacizumab, which blocks the blood supply a tumor builds for itself.

Who could take part, and the test that came first

501 people with hepatocellular carcinoma took part. This is the main type of primary liver cancer. Their tumors could not be removed by surgery, and none had received drug treatment for the cancer before. They were assigned 2 to 1: 336 to the combination, 165 to sorafenib.

Everyone needed well-preserved liver function, graded Child-Pugh A. Most liver cancer grows in a liver already damaged by hepatitis or alcohol, so this excluded a large group of real patients.

There was a second gate. Bevacizumab raises the risk of bleeding, and swollen veins in the esophagus are common in cirrhosis. Participants had an endoscopy first. Anyone with untreated varices was not suitable until they were dealt with. That step is still part of using this combination today.

What the first analysis showed

The trial had two main measures: overall survival, and time without the cancer worsening.

At the first analysis in August 2019, the hazard ratio for death was 0.58 (95% CI 0.42 to 0.79; p<0.001). That is roughly a 42% lower risk of dying at any moment. At twelve months, 67.2% of the combination group were alive (95% CI 61.3 to 73.1), against 54.6% on sorafenib (95% CI 45.2 to 64.0).

Median time without worsening was 6.8 months (95% CI 5.7 to 8.3) against 4.3 months (95% CI 4.0 to 5.6), hazard ratio 0.59 (95% CI 0.47 to 0.76; p<0.001).

What another year of follow-up added

Survival medians were not yet reached at the first analysis. A later report, after roughly twelve more months, filled them in. Median overall survival was 19.2 months with the combination and 13.4 months with sorafenib, hazard ratio 0.66 (95% CI 0.52 to 0.85). That is a gap of about 5.8 months.

Severe side effects were similar overall in the first report: grade 3 or 4 events in 56.5% against 55.1%. Severe high blood pressure affected 15.2% of the combination group.

What this does and doesn't change

• It changed the starting point for advanced liver cancer, and brought immune treatment into routine liver care.
• It does not apply to people with more advanced liver damage. Only Child-Pugh A livers were studied.
• Nobody was blinded. Patients and doctors knew which treatment was which, which can colour how side effects and scans are judged.
• It does not remove the need for the endoscopy, or the bleeding risk that makes it necessary.

Questions for a liver cancer clinic

• What is my Child-Pugh grade, and does it allow this combination?
• Have I had an endoscopy to check for varices, and what did it show?
• What would we do if my blood pressure rises on treatment?
• If this stops working, what comes next?

Sources

This article was written from the sources below, which were checked on the source-check date shown above.

• NEJM: Atezolizumab plus Bevacizumab in Unresectable Hepatocellular Carcinoma (IMbrave150) (primary)
• Journal of Hepatology: Updated efficacy and safety data from IMbrave150 (primary)

How this article was prepared

Prepared by Cancer Explained's AI-assisted editorial system and checked against the sources listed below. This article has not been reviewed by a healthcare professional unless a named reviewer is specifically shown.

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