1.1 Atezolizumab plus bevacizumab is recommended as an option for treating advanced or unresectable hepatocellular carcinoma (HCC) in adults who have not had previous systemic treatment, only if:
they have Child‑Pugh grade A liver impairment and an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1 and
the company provides it according to the commercial arrangement.
1.2 This recommendation is not intended to affect treatment with atezolizumab plus bevacizumab that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop.
Why the committee made these recommendations
Standard care for advanced or unresectable HCC is either sorafenib or lenvatinib for people who have not had previous systemic treatment. Atezolizumab plus bevacizumab is a potential new treatment option.
Clinical trial evidence shows that people with Child-Pugh grade A liver impairment and an ECOG performance status of 0 or 1 who have atezolizumab plus bevacizumab live longer and have longer before their disease progresses than people who have sorafenib. Results of an indirect comparison suggest that atezolizumab plus bevacizumab is more effective than lenvatinib. But this is uncertain because there is no direct evidence comparing them.
Despite the uncertainty in the indirect comparison, the most likely cost-effectiveness estimates for atezolizumab plus bevacizumab compared with sorafenib and with lenvatinib are within what NICE considers an acceptable use of NHS resources. Therefore, atezolizumab plus bevacizumab is recommended.