HCC: ‘landmark’ immunotherapy combination listed on PBS

The PBS listings for atezolizumab (Tecentriq) and bevacizumab (Avastin) have been expanded to allow use in combination to treat patients with advanced unresectable hepatocellular carcinoma.

From 1 November, more than 500 patients a year will be able to access the combination of a PD-L1 immunotherapy and anti-VEGF therapy for the treatment of unresectable locally advanced or metastatic Barcelona Clinic Liver Cancer (BCLC) Stage B or Stage C HCC who have not received prior systemic therapy.

The listing was recommended at the July 2020 meeting of the PBAC, which found that there was a high clinical need in this patient population and recognised the substantial clinical benefit provided by atezolizumab and bevacizumab, “despite the immaturity of the overall survival data”.

The combination was recently hailed as a landmark in therapy for advanced liver because it was the first to improve survival beyond sorafenib. A trial published in the NEJM concluded it to be “a new benchmark for first-line therapy in advanced HCC”.

The listing was based on evidence from the IMbrave150 study which showed that the immunotherapy combination improved overall survival (OS) by 42% (hazard ratio [HR]=0.58) and progression-free survival (PFS) by 41% (HR=0.59), compared with sorafenib.

Associate Professor Lara Lipton, a Melbourne medical oncologist and principal investigator in Australia for the IMbrave150 trial, described the PBS listing of the Tecentriq combination as a significant milestone improving overall survival and quality of life for patients in comparison to the previous standard of care.

“In most patients with unresectable hepatocellular carcinoma, the disease is diagnosed at advanced stages with a five-year survival rate of only 19% in Australia,” she said.

“Following the PBS listing, we now have a much-needed treatment available for people living with HCC.”

Hepatitis Australia welcomed the PBS listing, saying it had called for the combination to be made available to the increasing number of people with Hepatitis B and C who develop liver cancer.

“Inoperable hepatocellular carcinoma is the most common form of liver cancer with tragically one of the lowest survival rates of all cancers.” said CEO Carrie Fowlie.

“These liver cancer medicines are shown to increase survival rates, decrease disease progression, and provide more time with higher quality of life and physical functioning for patients.”


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