Effectiveness and Safety of Immunotherapy for Hepatocellular Carcinoma in Clinical Practice: A Brazilian Multicenter Study

da Fonseca LG, Freire CS, Guedes RAV, et al. JCO Glob Oncol. 2025 Jul;11:e2500128. PMID: 40737578.

Introduction

This study assesses real-world effectiveness and safety of immunotherapy for advanced hepatocellular carcinoma in Brazil, an underrepresented population with diverse clinical characteristics.

Study Type: Observational multicenter cohort

Population: 163 patients with unresectable/metastatic HCC

Intervention: Immunotherapy, mainly atezolizumab + bevacizumab (77.9%)

Outcomes: Overall survival, adverse events, prognostic factors

Key Findings

• Median OS 14.7 months; 12-/24-month survival rates 57.0%/41.4%
• Child-Pugh A & ECOG 0-1 patients median OS 20.6 months
• Immune-related adverse events in 19.6%, mainly thyroid/skin
• Bevacizumab-related variceal bleeding in 3.7%
• Low liver function (ALBI 2-3), MASLD, varices independently predict worse survival

Context & Related Research

• da Fonseca et al., 2025: Real-world Brazilian cohort confirms median OS 14.7 months with atezolizumab + bevacizumab and highlights prognostic importance of ALBI, MASLD, and varices (PMID:40737578).
• Finn et al., 2020: Pivotal IMbrave150 RCT established atezolizumab + bevacizumab efficacy in unresectable HCC, showing superior survival to sorafenib (PMID:32402160).
• Gao et al., 2023: Meta-analysis of real-world studies reported outcomes consistent with pivotal trial, confirming external validity (PMID:37415136).
• Hatanaka et al., 2023: Japanese multicenter study supports ALBI grade and viral status as survival predictors (PMID:36226511).
• Chon et al., 2023: Biomarker study highlights MASLD as an independent predictor of reduced survival with immunotherapy (PMID:35997637).
• Tomonari et al., 2023: Real-world data emphasizes liver function reserve (ALBI) as key for immunotherapy outcomes (PMID:35964253).

Clinical Implications

• Immunotherapy is effective and safe for advanced HCC in diverse Brazilian clinical settings.
• Baseline assessment of liver function and variceal status is critical for risk stratification and management.
• Metabolic dysfunction-associated steatotic liver disease (MASLD) patients require closer monitoring.

Strengths & Limitations

Future Directions

Further prospective studies are needed on immunotherapy in Child-Pugh B liver function patients and management of variceal bleeding risk. More data on MASLD long-term impacts will aid personalized care.

Conclusion

Immunotherapy for hepatocellular carcinoma demonstrates effectiveness and manageable safety in real-world practice, with survival influenced by liver function, etiology, and variceal status, emphasizing personalized management.

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Citations

1. da Fonseca LG, Freire CS, Guedes RAV, et al. JCO Glob Oncol. 2025 Jul;11:e2500128. PMID: 40737578.
2. Finn RS, Qin S, Ikeda M, et al. N Engl J Med. 2020 May 14;382(20):1894-1905. PMID: 32402160.
3. Gao S, et al. Comprehensive real-world assessment of immunotherapy efficacy in HCC. Hepatol Res. 2023. PMID: 37415136.
4. Hatanaka T, et al. Liver Int. 2023; PMID: 36226511.
5. Chon HS, et al. Biomarkers of immunotherapy response in HCC. J Hepatol. 2023; PMID: 35997637.
6. Tomonari T, et al. Liver function reserve as predictor of ICI outcomes. Cancer Immunol Immunother. 2023; PMID: 35964253.