ESMO 2025 | TRIPLET-HCC: ipilimumab, atezolizumab, and bevacizumab in 1L uHCC

TRIPLET-HCC is an academic French trial. It is a phase two, three randomized trial that tested two different arms, atezolizumab plus bevacizumab, that is one of the standards of care for a first line, for a treatment of patients in the advanced setting in HCC in first line. And the other arm is represented by a triple combination, atezolizumab, bevacizumab and ipilimumab. The authors presented the results of the phase two part that is a non-comparative randomized part of the study and the primary endpoint was overall response rate of at least 35% in the triple combination arm. Unfortunately, the trial is negative. This primary endpoint was not met, and so the trial will not go on to the phase 3 part. What is interesting here is that the results in the triple combination arm are quite similar to the results achieved in the double combination arm, atezolizumab plus bevacizumab, and quite similar to the results achieved in the IMbrave150, that was the registrational trial, the phase 3 trial for atezolizumab plus bevacizumab. However, in terms of safety, there were more adverse events in the triple combination arm. So probably the triple combination anti-VEGF, anti-PD-1, anti-CTLA-4 can be, or at least based on these results, seems to be a little bit too toxic for patients with the HCC. So the take home message, the key message from this trial is that the triple combination did not add significant benefit while adding maybe something in terms of toxicity. So this is not something that will have an opportunity to be translated in clinical practice.

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