180P Real-world outcomes of patients with hepatocellular carcinoma receiving first-line atezolizumab with bevacizumab: A UK Midlands cohort

Background
The IMbrave150 trial established atezolizumab plus bevacizumab (ATE/BEV) as a first-line standard of care for patients with unresectable hepatocellular carcinoma (HCC), demonstrating improved overall survival (OS) and progression-free survival (PFS) over sorafenib. Ongoing real-world data collection are needed to assess ATE/BEV effectiveness and safety.

Methods
Retrospective data were collected from 3 oncology centres in the Midlands, UK, with local audit committee approval. Eligible patients were required to have a diagnosis of HCC confirmed by histological biopsy wherever feasible.

Results
As of August 2025, 332 patients were included in analysis, with a median time to follow-up of 12 months [95% CI: 10.1 – NA]. The median OS was 16.5 months [95% CI: 14.2 – 20.7], with a 6-month OS of 76.8% [95% CI: 71.6 – 82.5]. The median PFS was 12.3 months [95% CI: 10 – 16.3], with a 6-month progression-free survival of 70.8% (95% CI: 64.6 - 77.6). The objective response rate (ORR) was 42.9%, with 100 partial or complete responses (95% CI: 42.5% - 56.1%). 190 of 233 (81.54%) patients discontinued the treatment at time of analysis, with a median time to discontinuation of 6.5 months (95% CI: 5.9 – 8.3 months). Reasons for discontinuation included progression (47.4%), toxicity (22.6%) and liver decompensation (17.9%). 91 of 233 (39.06%) patients received a second-line therapy after stopping ATE/BEV. Adverse events of any grade occurred in 96 patients (41.2%); 54 patients (23.2%) had ≥ grade 3 toxicity that warranted treatment cessation of combination ATE/BEV. 74 patients (31.8%) experienced ATE-related adverse event, all grade 2 or above. 26 patients (11.2%) experienced a BEV-related toxicity ≥ grade 3 toxicity. Within, we report the spectrum of presentations related to toxicity from each treatment.

Conclusions
In this real-world multicentre UK cohort, ATE/BEV demonstrated survival outcomes comparable to IMBrave 150 trial data, with manageable toxicity and a substantial proportion of patients proceeding to second-line therapy. These findings support the robustness of ATE/BEV as first-line standard of care in unresectable HCC beyond clinical trial settings.