Atezolizumab and bevacizumab as first line therapy in advanced hepatocellular carcinoma: Practical considerations in routine clinical practice

Abstract

Hepatocellular carcinoma (HCC) is the most common primary liver cancer. For advanced HCC, sorafenib was considered the standard of care for more than ten years. Recently the atezolizumab and bevacizumab combination has become standard of care for these patients without contraindications to either immune checkpoint inhibitors or antiangiogenic therapy. We now review the practical aspects of the atezolizumab and bevacizumab combination, including current evidence, indications, contraindications, management of adverse events, sequencing of this combination, areas of current knowledge gaps and future areas of active clinical research of this combination for busy clinicians in clinical practice.

Keywords: Hepatocellular carcinoma; Atezolizumab; Bevacizumab; Immunotherapy; Child Pugh cirrhosis; Anti-angiogenic therapy

Core Tip: There are several articles about the role of atezolizumab and bevacizumab combination in advanced unresectable hepatocellular carcinoma. However, this mini review focuses on practical issues for clinicians using this combination in hepatocellular carcinoma (HCC) patients with focus on indications, data from recent trials, criteria for selection of appropriate patients for this combination, sequencing strategies, overlapping toxicities, issues with Child Pugh B cirrhosis patients, future role in adjuvant settings and dealing with special subsets of HCC population.