Multidisciplinary strategies including local treatment to achieve drug-free status after atezolizumab plus bevacizumab treatment in hepatocellular carcinoma.

Atezolizumab plus bevacizumab (AteBev) is used as a first-line treatment for advanced hepatocellular carcinoma (HCC). Combining AteBev with sequential local treatment holds potential; however, optimal timing, modality and continuation of systemic chemotherapy remain undetermined. In the present study, a retrospective analysis of 123 patients with HCC treated with AteBev at two institutions was performed. Patients with no apparent residual lesions after sequential local treatment or AteBev treatment alone were followed up without any systemic chemotherapy ('drug-free' cohort). Outcomes focused on the impact of achieving 'drug-free' status, with timing assessed based on tumor size and α-fetoprotein levels. The results revealed that serum α-fetoprotein levels and tumor shrinkage plateaued at ~3 and 6 months post-AteBev treatment, respectively. Patients achieving 'drug-free' status demonstrated prolonged median survival (P<0.001) and progression-free survival (P<0.001), comparable with patients with 'clinical complete response' or 'drug-off' statuses. Moreover, particle radiotherapy was the most common local treatment modality. In conclusion, achieving a 'drug-free' status was associated with favorable prognoses. Optimal timing for sequential local treatment is suggested as 3-6 months after AteBev initiation, with multidisciplinary strategies to achieve 'drug-free' status offering a promising option for the treatment of advanced HCC.