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ESMO 2025 | TALENTop: liver resection vs continued atezolizumab & bevacizumab in HCC
Stephen Lam Chan, MD, FRCP, Chinese University of Hong Kong, Hong Kong, China, comments on the Phase III TALENTop trial (NCT04649489) comparing liver resection versus continued atezolizumab plus bevacizumab in patients with locally advanced hepatocellular carcinoma who achieved partial response or stable disease after initial atezolizumab/bevacizumab treatment. Liver resection significantly improved time-to-treatment failure compared with continued systemic therapy, with a trend toward overall survival benefit. Safety was manageable, with expected surgical and systemic adverse events. This interview took place at the European Society for Medical Oncology (ESMO) 2025 Congress in Berlin, Germany.
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Transcript
I think in the ESMO meeting, there’s another trial that I think that caught my interest. It’s the TALENTop study. And the TALENTop study basically is also a study run in China. Those patients with a borderline or inoperable HCC to start with, but with the absence of the extrahepatic diseases, and then they receive the atezolizumab and bevacizumab. So afterwards, if the patient demonstrated a partial response or stable disease, and then they randomize those patients to continuation of atezolizumab and bevacizumab, and then the experimental arm is to surgery, if there’s a resectable disease...
I think in the ESMO meeting, there’s another trial that I think that caught my interest. It’s the TALENTop study. And the TALENTop study basically is also a study run in China. Those patients with a borderline or inoperable HCC to start with, but with the absence of the extrahepatic diseases, and then they receive the atezolizumab and bevacizumab. So afterwards, if the patient demonstrated a partial response or stable disease, and then they randomize those patients to continuation of atezolizumab and bevacizumab, and then the experimental arm is to surgery, if there’s a resectable disease. So, and then followed by some one year total adjuvant atezolizumab and bevacizumab. So basically, it’s a testing concept that for those patients with partial response SD and operable cases, whether they benefit from surgery on top of that atezolizumab and bevacizumab. So from the readout, the time, the kind of treatment failure or recurrence is that there have been improvement favoring the surgical arm. Of course, I think we need to wait for a longer readout and also some of the readout from the overall survival. But overall, this suggested that perhaps we need some more MDT or patient-centered approach according to the response achieved from the immunotherapy. For those patients who really have good response, instead of continuation of the atezolizumab and bevacizumab, we may offer some of them to surgery, and they do have some benefit from the surgical treatment. So I would say this is an important study. Of course, in the study, they do observe 20 plus percentage of a grade three, four treatment-related AE after the surgery. So I think we need to look in more details what are those toxicities and before we really adopt these practices, but definitely points to an important concept that we need some more response-adapted surgical approach for these type of more advanced HCC.
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