This study provides the longest prospective real-world follow-up of atezolizumab plus bevacizumab, confirming its durable benefit.Four-year updates from the CHIEF study show a durable survival benefit with atezolizumab plus bevacizumab in individuals with advanced hepatocellular carcinoma (HCC).
After a median follow-up of 48 months, overall survival (OS) was 29 percent, and the median OS was 17.8 months. The strongest predictors of mortality were vascular invasion (hazard ratio [HR], 1.39; p=0.03) and albumin–bilirubin (ALBI) grade 2 score (HR, 1.63; p=0.003) in the multivariate analysis.
The median progression-free survival (PFS) was 10 months, with ALBI grade 2 (HR, 1.34; p=0.04) and grade 3 (HR, 1.74; p=0.02) as the strongest predictive factors of progression. [ESMO GI 2026, abstract 241P]
Forty-two percent of the participants had an objective response (complete or partial response), 42 percent had stable disease, and 16 percent had progressive disease. The best response rates did not differ by Barcelona Clinic Liver Cancer (BCLC) classification, age and gender, Child-Pugh score, ALBI grade, underlying liver disease, or alpha-fetoprotein (AFP) level.
Moreover, some responses enabled conversion to curative-intent treatment, the researchers noted. Thirty-seven patients underwent curative-intent conversion, the most common being resection (n=19), followed by liver transplants and ablative therapies (n=9 each).
At 48 months, OS probability was higher among participants who had received curative treatment than among those who underwent locoregional and systemic therapies (p<0.0001).
The mean quality-of-life scores (European Organisation for Research and Treatment of Cancer QLQ-C30*, QLQ-HCC18**) were relatively comparable across visits, and the median time to deterioration was 12 months. “The quality of life of participants remained preserved, supporting the good tolerability [of the combination regimen] in routine practice,” the investigators said.
The QLQ-C30 domains evaluated were global health, fatigue, pain, loss of appetite, and diarrhoea. The QLQ-HCC18 domains evaluated were fatigue, pain, and jaundice.
Study characteristics
“The IMbrave150 trial positioned the atezolizumab and bevacizumab combination as first-line treatment for advanced HCC,” the investigators noted. The IMbrave150 results heralded the age of anticancer immunotherapy in unresectable HCC by demonstrating the superiority of this combination regimen in improving OS and PFS compared with sorafenib among treatment-naïve patients with unresectable HCC. [N Engl J Med 2020;382:1894-1905; J Hepatol 2022;76:862-873; JHEP Rep 2025;7:101431]
To report the first long-term real-world data from the French CHIEF cohort, the researchers conducted this large prospective multicentre cohort study across 33 French centres from 2020 to 2025 and included 880 patients who received atezolizumab plus bevacizumab in the first-line setting. Eighty-eight percent of the participants were men, and the average age was 69 years.
The most frequent underlying liver disease was at least alcohol related (58 percent), followed by alcohol-related only (28 percent), metabolic dysfunction-associated steatotic liver disease only (16 percent), and viral only (14 percent).
Seventy-eight percent of the participants had Child-Pugh A, nearly two-thirds (61 percent) had an ALBI grade 2 score, 55 percent had oesophageal varices, and 20 percent had a history of liver decompensation.
Regarding HCC features, 67 percent had BCLC C, 35 percent had the multinodular form, 47 percent had vascular invasion, 32 percent had metastasis, and 30 percent had an AFP level >400 ng/mL.
“This 4-year CHIEF update provides the longest prospective real-world follow-up of atezolizumab plus bevacizumab, confirming its durable benefit,” the investigators said.