AIM: A clinical trial (IMbrave150) indicated the efficacy and safety of 
atezolizumab plus bevacizumab for patients with unresectable hepatocellular 
carcinoma (HCC). In this study, we evaluated this therapeutic combination in a 
real-world setting, with a focus on patients who did not meet the IMbrave150 
eligibility criteria.
METHODS: In this multicenter study, patients with unresectable HCC treated with 
atezolizumab plus bevacizumab between October 2020 and May 2021 were screened. 
In patients who did not meet IMbrave150 eligibility criteria, treatment 
responses and safety at 6 and 12 weeks were evaluated.
RESULTS: Atezolizumab plus bevacizumab was initiated in 64 patients, including 
46 patients (71.9%) who did not meet IMbrave150 eligibility criteria. Most of 
these patients had a history of systemic therapy (44/46). The objective response 
rate and disease control rate observed using Response Evaluation Criteria in 
Solid Tumors 1.1 were 5.2% and 82.8% at 6 weeks and 10.0% and 84.0% at 12 weeks, 
respectively; these rates were similar between patients who met and did not meet 
the IMbrave150 criteria. Ten patients experienced progressive disease (PD) at 
6 weeks. Portal vein tumor thrombosis was significantly associated with PD 
(p = 0.039); none of the 15 patients with hepatitis B virus-related HCC 
experienced PD (p = 0.050). The most common adverse events of grade 3 or higher 
were aspartate aminotransferase elevation (n = 8, 13.8%) and the safety profile 
was similar between patients who met and did not meet the IMbrave150 criteria.
CONCLUSION: Most patients treated with atezolizumab plus bevacizumab did not 
meet the IMbrave150 criteria; however, the combination therapy showed good 
safety and efficacy at the early treatment phase.