Who is this for?
This is for people with advanced liver cancer (hepatocellular carcinoma) that can’t be removed by surgery, and who haven’t yet had drug treatment for it.
Liver cancer is common worldwide and often arises in a liver already scarred by hepatitis or cirrhosis — which limits how much treatment the liver can safely take. The people in this trial had reasonably preserved liver function, which matters for tolerating treatment.
What kind of trial is this?
IMbrave150 was a global phase III randomized trial — the most rigorous kind. It compared the immunotherapy combination against sorafenib, the pill that had been the standard first treatment for advanced liver cancer for over a decade.
Background: a decade stuck on one pill
For advanced liver cancer, the pill sorafenib had been the standard first treatment since 2007 — and for years, trial after trial failed to beat it. It helped only modestly, and its side effects (fatigue, hand-foot soreness, diarrhea) wore people down.
The idea behind IMbrave150 was to attack the cancer two ways at once: unleash the immune system with atezolizumab, and cut off the tumor’s blood supply with bevacizumab — which, as a bonus, helps immune cells get into the tumor. The question was whether this combination could finally do better than sorafenib.
The trial: what was tested and how
IMbrave150 enrolled 501 people with untreated, unresectable liver cancer. They were randomly assigned (2 to 1) to one of two treatments:
- Atezolizumab + bevacizumab (336 people): both given by infusion every 3 weeks.
- Sorafenib (165 people): the standard pill, twice daily.
The two main measures were how long people lived (overall survival) and how long the cancer was held in check (progression-free survival).
Results: what they found
The immunotherapy combination beat sorafenib on survival, on shrinking the tumor, and on quality of life.
Atezolizumab + bevacizumab vs sorafenib
The risk of death was 42% lower with the combination (HR 0.58) — the first regimen in over a decade to help people with advanced liver cancer live longer than sorafenib.
The tumor measurably shrank more than twice as often, and completely disappeared in about 6% of people on the combination (versus none on sorafenib).
People not only lived longer but felt well for longer — quality of life held up about three times as long as with the harsher pill (HR 0.63).
What is hepatocellular carcinoma?
It’s the most common cancer that starts in the liver, and it usually develops in a liver that has been damaged over years — most often by hepatitis B or C infection, heavy alcohol use, or fatty liver disease. Because the underlying liver is often not healthy, treatment has to balance fighting the cancer against protecting what liver function remains.
How do the two drugs work together?
Atezolizumab is immunotherapy: it blocks PD-L1, a “brake” the cancer uses to switch off immune cells, freeing them to attack. Bevacizumab blocks VEGF, the signal tumors use to grow their own blood vessels — starving the tumor and, importantly, making the tumor’s environment friendlier for immune cells to get in. Together they attack the cancer in two complementary ways.
Is there a bleeding risk?
Yes — bevacizumab can increase the risk of bleeding, and liver cancer patients sometimes have enlarged veins in the esophagus (varices) that can bleed. For that reason, people are usually checked with an endoscopy before starting, and any risky varices are treated first. High blood pressure is the most common serious side effect of the combination; immune-related side effects can also occur.
The bottom line
For advanced liver cancer, atezolizumab plus bevacizumab was the first treatment in over a decade to beat the old standard pill — helping people live longer (67% vs 55% alive at one year), shrinking the tumor more than twice as often, and preserving quality of life for far longer. It became the new first-choice treatment for people with unresectable liver cancer and reasonably preserved liver function.
What this could mean for you
- Immunotherapy-based treatment comes first. For advanced liver cancer, a single old-style pill is no longer the default first treatment.
- Liver function matters. This combination is for people whose liver is still working reasonably well; that’s part of the assessment.
- A pre-treatment endoscopy is standard. Because of the small bleeding risk, doctors usually check for and treat enlarged veins first.
- Better living, not just longer. A notable strength here was preserved quality of life — worth weighing alongside survival.
Questions & comments
Have a question about this research? Ask below. Questions are read and answered by the site. We can’t give personal medical advice, but we’re glad to explain the research more clearly.