Combination Therapy of TACE, Atezolizumab, and Bevacizumab Enhances PFS in HCC

In a landmark study presented at the 2025 European Society for Medical Oncology (ESMO) Gastrointestinal Cancers Congress, a combination therapy involving Transarterial Chemoembolization (TACE), atezolizumab (Tecentriq), and bevacizumab (Avastin) has demonstrated a significant improvement in progression-free survival (PFS) for patients with unresectable hepatocellular carcinoma (HCC). The phase 3 TALENTACE trial revealed that patients receiving the combination therapy exhibited a median PFS of 11.30 months, compared to just 7.03 months for those treated with TACE alone, marking a noteworthy advancement in treatment options for this challenging cancer type.

The TALENTACE trial, which enrolled 342 patients diagnosed with intermediate-to-high tumor burden unresectable HCC, was designed as a multicenter, open-label study. Participants were randomly assigned to receive either the combination therapy or TACE alone. According to Dr. Guohong Han, a leading oncologist at Xi’an International Medical Center Hospital in China and principal investigator of the study, the results met the primary endpoint of the trial, showcasing a hazard ratio of 0.71 (95% CI, 0.55-0.92) with a p-value of .009, indicating a statistically significant improvement in PFS with the combination treatment.

In addition to the enhanced median PFS, the study reported higher objective response rates (ORR) in the combination therapy group, with 81.3% of patients achieving a complete or partial response, compared to 66.7% in the TACE-alone group. Notably, the safety profile of the combination therapy was deemed manageable, although treatment-related adverse events were more prevalent in the group receiving the combination therapy.

The TALENTACE trial is particularly significant as it is the first phase 3 study to confirm the efficacy and safety of TACE combined with immunotherapy agents, specifically atezolizumab and bevacizumab, for patients with untreated intermediate-to-high tumor burden unresectable HCC. As Dr. Han emphasized, this combination therapy provides a new therapeutic pathway for patients who have not previously received systemic or locoregional therapies.

The patient population in the trial primarily consisted of middle-aged men, with a median age of 62 years. The majority were classified under the BCLC-B disease stage, indicating a serious progression of HCC. The results also highlighted the potential of this combination therapy to be utilized in specific patient demographics, particularly in regions with high incidences of liver cancer, such as China and Japan.

While the median overall survival (OS) data were still immature at the time of the analysis, preliminary findings indicated a median OS of 34.53 months for the combination therapy versus 35.38 months for TACE alone, suggesting that although OS data require further follow-up, the combination treatment may enhance PFS without compromising overall survival.

The findings from the TALENTACE trial suggest a paradigm shift in the management of unresectable HCC, emphasizing the importance of combining local and systemic therapies to enhance patient outcomes. The results will likely influence clinical practice guidelines and treatment protocols, paving the way for enhanced therapeutic strategies in managing hepatocellular carcinoma. As the research continues, healthcare professionals remain optimistic about integrating these findings into standard care practices for patients facing this formidable cancer.

Future research will need to further elucidate the long-term benefits and potential risks associated with this combination therapy, as well as investigate its applicability in broader patient populations. The ongoing studies and trials will be critical in determining the optimal therapeutic approach for improving survival rates and quality of life for patients battling unresectable HCC.