Phase 3 TALENTop trial: liver resection after atezolizumab and bevacizumab lengthens time to treatment failure in locally advanced hepatocellular carcinoma

In the randomised phase 3 TALENTop trial (24 hospitals in China), 201 patients with hepatocellular carcinoma and macrovascular invasion who had responded to induction atezolizumab plus bevacizumab were randomly assigned to liver resection followed by maintenance treatment or to maintenance treatment alone. Median time to treatment failure was 20.4 months in the surgery group versus 11.8 months in the maintenance group (HR 0.60, 95% CI 0.39-0.91; p=0.015) after a median follow-up of 18.4 months. The advantage came at a safety cost: grade 3-4 treatment-related adverse events occurred in 39% of the surgery group versus 21% of the maintenance group, with two treatment-related deaths in the surgery group. The primary endpoint was time to treatment failure, NOT overall survival — the trial is ongoing and survival data have not been reported.