Interpreting IMbrave050 and the Unmet Need in the Adjuvant HCC Setting

This segment centers on the evolving evidence for adjuvant therapy in HCC, with a focused discussion on results from the IMbrave050 trial and how those findings should (or should not) inform frontline treatment decisions. Dr. Braiteh introduces the topic by asking whether recently reported IMbrave050 data in patients who underwent curative-intent resection or ablation might influence treatment selection in advanced disease.

Dr. Akçe clarifies an important practical distinction: although baseline EGD is not strictly required before initiating immune checkpoint inhibitor–only regimens, he routinely incorporates it into care to treat the patient holistically. For atezolizumab plus bevacizumab, however, he emphasizes that EGD results are essential prior to treatment initiation because of bleeding risk.

Turning to IMbrave050, Dr. Akçe explains that this was an adjuvant trial enrolling patients at high risk for recurrence following curative resection or ablation. Participants were randomized to active surveillance or one year of atezolizumab plus bevacizumab. Although interim results initially suggested an improvement in recurrence-free survival, the final analysis did not confirm a sustained benefit. As a result, Dr. Akçe chose not to adopt this regimen in the adjuvant setting based on interim findings alone, citing the significant commitment and potential burden of one year of systemic therapy.

Both faculty emphasize that the adjuvant HCC space remains an area of substantial unmet need, with multiple negative trials to date across both immunotherapy- and tyrosine kinase inhibitor–based strategies. Importantly, Dr. Akçe differentiates this setting from the frontline advanced HCC landscape, where several therapies have demonstrated clear efficacy and safety. Dr. Braiteh adds that adjuvant therapy may offer opportunities for earlier detection of complications in cirrhotic patients but acknowledges that definitive conclusions await further data.