Durvalumab and bevacizumab plus chemoembolization improves progression-free survival in hepatocellular carcinoma

1. Progression-free survival was significantly greater in the durvalumab plus bevacizumab group compared to placebo.

2. Common treatment-related adverse events included hypertension and anemia.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Transarterial chemoembolization (TACE) is the standard treatment for patients with unresectable, non-metastatic hepatocellular carcinoma. However, current survival outcomes still leave much to desire. One approach combines TACE with systemic therapies like durvalumab and bevacizumab to improve patient outcomes. This randomized controlled trial aimed to evaluate whether adding durvalumab and bevacizumab to TACE provides superior benefits compared to TACE alone. The primary outcome of this study was progression-free survival, while a key secondary outcome was overall survival. According to study results, patients receiving durvalumab and bevacizumab plus TACE had significantly longer progression-free survival compared to those receiving TACE alone. Although this study was well done, it was limited by the need for a longer follow-up to determine the impact on overall survival.

Click to read the study in The Lancet

Relevant Reading: Durvalumab after Chemoradiotherapy in Limited-Stage Small-Cell Lung Cancer

In-depth [randomized controlled trial]: Between Nov 30, 2019, and Jul 19, 2021, 887 patients were assessed for eligibility from 157 medical sites in 18 countries. Included were patients ≥ 18 years with unresectable hepatocellular carcinoma, an Eastern Cooperative Oncology Group performance status of 0 or 1, and at least one intrahepatic lesion. Altogether, 616 patients (204 to durvalumab plus bevacizumab, 207 to durvalumab plus placebo, and 205 to placebo only) were included in the final analysis. The primary outcome of progression-free survival showed a significant improvement in the group receiving durvalumab plus bevacizumab than placebo (15.0 months vs. 8.2 months, hazard ratio [HR] 0.77, 95% confidence interval [CI] 0.61-0.98, p<0.05). Common adverse events in the intervention group included hypertension (6%) and anemia (4%). Findings from this study suggest that adding durvalumab and bevacizumab to TACE may set a new standard of care for patients with unresectable hepatocellular carcinoma.

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