On-demand transarterial chemoembolisation combined with atezolizumab and bevacizumab in patients with untreated hepatocellular carcinoma (TALENTACE): a multicentre, randomised, open-label, phase 3 trial.
Masatoshi Kudo, Sadahisa Ogasawara, Ruibao Liu et al.
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In 30 seconds
TALENTACE was a multicentre, open-label, randomised phase 3 trial comparing on-demand transarterial chemoembolisation (TACE) plus atezolizumab and bevacizumab with TACE alone in 342 patients with untreated, unresectable hepatocellular carcinoma and intermediate-to-high tumour burden. At median follow-up of 26.25 months, median TACE progression-free survival was 11.30 months with combination treatment versus 7.03 months with TACE alone (HR 0.71 [95% CI 0.55–0.92]; p=0.0089). Overall survival was immature at this analysis, with no clear difference between groups.
Key findings
- Median TACE progression-free survival was 11.30 months with combination treatment versus 7.03 months with TACE alone (HR 0.71 [95% CI 0.55–0.92]; p=0.0089).
- At the first prespecified interim analysis, median overall survival was 34.53 months versus 35.38 months (HR 0.96 [99.62% CI 0.58–1.58]); survival data remained immature.
- Common grade 3–4 adverse events with combination treatment included decreased platelet count (14%), hypertension (14%), and post-embolisation syndrome (13%).
Why it matters
The trial suggests that adding atezolizumab and bevacizumab to on-demand TACE can delay progression to untreatable disease or other TACE failure in selected patients with unresectable hepatocellular carcinoma. However, the reported progression-free survival benefit has not yet translated into an established overall-survival advantage, so the balance of benefit and harms remains important to assess.
What to keep in mind
Overall survival was immature at the reported interim analysis. The open-label trial enrolled patients with Child-Pugh class A liver function and ECOG performance status 0–1, limiting applicability to patients outside these criteria.