Atezolizumab Plus Bevacizumab Combination Therapy in Unresectable Hepatocellular Carcinoma: An Institutional Experience

<b>Background:</b> Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality. Atezolizumab plus bevacizumab (Atezo/Bev) has emerged as a first-line therapy for unresectable HCC (uHCC), improving overall and progression-free survival (OS, overall survival and PFS, progression-free survival) in IMbrave150. This study evaluates the real-world efficacy and safety of Atezo/Bev in uHCC. <b>Methods:</b> A retrospective analysis was performed on 87 patients (median age 68 years) treated with Atezo/Bev at Houston Methodist Hospital between January 2020 and June 2023. Demographics, treatment patterns, radiological response, OS, PFS, and toxicities were reviewed. Atezo/Bev was administered per FDA guidelines (atezolizumab 1200 mg plus bevacizumab 15 mg/kg every 3 weeks). <b>Results:</b> Of 87 patients, 78% were male, 71% White, and 70% had BCLC stage C disease. Most (60%) had Child-Pugh class A liver function, and 62% had viral hepatitis. Median OS was 15.1 months (95% CI: 10.57-25.97) and PFS was 9.1 months (95% CI: 7.4-21.07). Objective response rate was 31.3% (CR 7.2%, PR 25%, SD 52%, PD 16%). OS was longer in CP A versus CP B patients (21.2 vs. 5.2 months, <i>p</i> < 0.001) and in those receiving post-Atezo/Bev locoregional therapy (21.2 vs. 10.4 months, <i>p</i> = 0.043). Discontinuation due to toxicity occurred in 14%, mainly gastrointestinal bleeding and fatigue. <b>Conclusions:</b> Atezo/Bev demonstrated favorable real-world efficacy and manageable toxicity in uHCC, particularly in patients with preserved liver function or multimodal therapy.