Following the string of approvals this year for Roche’s combination of Avastin (bevacizumab) and Tecentriq (atezolizumab), key opinion leaders interviewed by GlobalData from the five major European pharmaceutical markets (5EU*) and China have noted that the majority of patients would receive Avastin plus Tecentriq in the first-line setting. This offers a major competition to current standard of care (SoC) Nexavar. GlobalData notes that the combination has superiority over Nexavar, and it is expected to make huge changes in the HCC market landscape.

Mandana Emamzadeh, PhD, Healthcare Analyst at GlobalData, comments: “Prior to the approval of Roche’s combination of vascular endothelial growth factor (VEGF) and programmed death-ligand 1 (PD-L1) inhibitors, the key strategy for first-line advanced HCC was multikinase inhibitors (TKI) such as Bayer’s Nexavar and Eisai’s Lenvima (lenvatinib).”

“The approval of Avastin plus Tecentriq not only changes the SoC for HCC but also shifts the focus of research and development (R&D) toward combination therapies. This is a promising news for the combination therapies in Phase III of development such as Lenvima and Keytruda (by Eisai and Merck), Cabometyx and Tecentriq (by Exelixis and Roche), Imfinzi and tremelimumab (by AstraZeneca), Opdivo + Yervoy (by BMS).”

The superiority of the combination over Nexavar (sorafenib) is based on the results of the Phase III IMbrave150 study of patients with unresectable or metastatic HCC. In this study, the 12-month overall survival rate was 67.2% in the Avastin plus Tecentriq group, compared with 54.6% in the Nexavar group. While median overall survival was not reached in this study, median progression-free survival increased from 4.3 months in the Nexavar group to 6.8 months in patients treated with Avastin plus Tecentriq.Avastin plus Tecentriq is the first combination therapy emerging in the HCC market as the first-line treatment. The combination has already developed trust with physicians, and therefore, other combinations in the pipeline are facing tough competition to gain a position in the HCC market.

* 5EU: France, Germany, Italy, Spain and the UK