Atezolizumab plus Bevacizumab with Transcatheter Arterial Chemoembolization (Sandwich Strategy) versus Atezolizumab plus Bevacizumab Alone in Hepatocellular Carcinoma: A Multicenter Retrospective Study.

[INTRODUCTION] This study aimed to evaluate the effect of sandwiching on-demand transcatheter arterial chemoembolization (TACE) during atezolizumab (Atezo) and bevacizumab (Bev) therapy on overall survival (OS) and progression-free survival (PFS) in patients with unresectable hepatocellular carcinoma (HCC).

[METHODS] We retrospectively analyzed 398 patients who started Atezo/Bev therapy between October 2020 and April 2024. Overall, 245 patients were included: 51 in the ABC-TACE sandwich group and 194 in the Atezo/Bev alone group. Propensity score matching was performed to balance baseline characteristics, resulting in 49 matched patients per group. OS and PFS were analyzed using the Kaplan-Meier methods, with landmark analysis to adjust for immortal time bias. Multivariate analysis identified independent predictors of OS and PFS.

[RESULTS] The ABC-TACE sandwich group had significantly longer OS (median, not reached vs. 21.0 months, < 0.05) and PFS (18.7 months vs. 11.2 months, < 0.05) than the Atezo/Bev alone group. Landmark analysis showed prolonged OS at multiple time points in the ABC-TACE sandwich group ( < 0.05, < 0.05, = 0.078). TACE independently contributed to both OS and PFS. No significant differences in adverse events were observed between the groups. No deterioration in the Child-Pugh score was observed before and after TACE ( = 0.976).

[CONCLUSION] Sandwiching TACE during Atezo/Bev therapy may improve survival outcomes for unresectable HCC.