IMbrave150
In systemic-treatment-naive unresectable HCC, does atezolizumab plus bevacizumab improve outcomes compared with sorafenib?
Reported outcome visualization
Key results
At updated median follow-up 15.6 months, median OS was 19.2 vs 13.4 months (HR 0.66, 95% CI 0.52–0.85; descriptive P<.001); median PFS was 6.9 vs 4.3 months (HR 0.65, 95% CI 0.53–0.81). At 18 months, OS was 52% vs 40%. Grade 3/4 treatment-related AEs occurred in 43% vs 46%; grade 5 treatment-related events 2% vs <1%.
Absolute Effect
18-month OS absolute improvement 12 percentage points; NNT ≈9 at 18 months. Landmark estimate from the updated analysis; interpret with the specified cutoff and survival estimation.
NNT: ≈9, based on 18-month overall survival.
NNH: Not calculated: the selected trial-wide toxicity comparison is not a single, consistently higher fixed-time endpoint (grade 3/4 treatment-related AEs 43% vs 46%; grade 5 2% vs <1%).
Time-to-event interpretation: Hazard ratios and median survival are relative/time-to-event measures; they are not converted into NNT unless a fixed-time absolute event estimate is available.
Toxicity and treatment burden
Bleeding risk from bevacizumab is central, especially with portal hypertension/varices; endoscopic evaluation and treatment of varices before therapy are important. Grade 3/4 treatment-related toxicity was 43% vs 46%; grade 5 events were 2% vs <1%.
Follow-up, limitations and maturity
Follow-up: Median follow-up 15.6 months in the updated analysis.
Evidence applies mainly to Child-Pugh A, ECOG 0–1 patients; benefit-risk in decompensated cirrhosis is uncertain. Open-label trial and bleeding risk require careful selection. This was versus sorafenib, not other modern first-line combinations.
Clinical interpretation
Atezolizumab–bevacizumab improved survival over sorafenib and became a first-line standard for eligible advanced HCC, provided bleeding risk and portal hypertension are assessed.
Primary publication and sources
Finn RS, et al. N Engl J Med. 2020;382:1894–1905; updated analysis Finn RS, et al. J Hepatol. 2021.
Current-practice context · reviewed 15 October 2026
Atezolizumab plus bevacizumab remains a first-line option for eligible patients with advanced HCC, alongside durvalumab plus tremelimumab. The choice depends on liver function, performance status, autoimmune risk, bleeding/thrombosis risk, patient preference and access. Before atezolizumab–bevacizumab, assess and manage oesophageal varices and portal-hypertension-related bleeding risk; pivotal evidence chiefly applies to Child-Pugh A, ECOG 0–1 patients.
ASCO 2024 guideline update for systemic therapy in advanced HCC ↗