At this year’s ESMO Congress, several new studies in liver and bile duct cancers revealed how immunotherapy and targeted treatments are reshaping care. Researchers are exploring earlier use, new combinations, and more effective ways to help patients live longer and better.

1. New Immunotherapy Combination in Advanced Liver Cancer – IMbrave152 (SKYSCRAPER-14) Trial

The phase 3 IMbrave152 trial tested whether adding a new immunotherapy drug, tiragolumab, to the standard combination of atezolizumab plus bevacizumab could further improve outcomes for people with advanced liver cancer.

Patients were randomly assigned to receive either the three-drug combination or the standard two-drug treatment with a placebo. The results showed that adding tiragolumab did not significantly extend survival or slow cancer growth compared with the existing standard treatment. Side effects were generally similar between the two groups, although immune-related reactions occurred slightly more often with tiragolumab.

Key takeaway: Adding tiragolumab to atezolizumab and bevacizumab did not improve outcomes in advanced liver cancer. The current two-drug standard remains the best available option, while researchers continue to search for more effective immunotherapy combinations.

2. Immunotherapy versus Local Treatment in Intermediate Liver Cancer – ABC-HCC Trial

The phase 3 ABC-HCC trial compared the immunotherapy combination atezolizumab plus bevacizumab with the traditional local treatment transarterial chemoembolisation (TACE) in people with intermediate-stage hepatocellular carcinoma (HCC).

TACE has long been the standard for this stage of disease, delivering chemotherapy directly to the tumour while blocking its blood supply. Researchers aimed to see if systemic immunotherapy could provide longer-lasting control.

Results showed that atezolizumab plus bevacizumab delayed disease progression for longer than TACE, suggesting this approach could become an effective alternative for certain patients whose tumours are difficult to treat locally.

Key takeaway: The atezolizumab and bevacizumab combination demonstrated longer disease control than TACE for some patients with intermediate-stage liver cancer. Further data will help determine whether this treatment can replace current standard care.

3. Triple Combination Therapy Before Surgery in Bile Duct Cancer – Toripalimab + Lenvatinib + GEMOX

A new trial tested a three-drug combination—toripalimab (immunotherapy), lenvatinib (targeted therapy), and GEMOX (chemotherapy)—as a neoadjuvant treatment (given before surgery) for patients with advanced intrahepatic cholangiocarcinoma (bile duct cancer). The goal was to shrink tumours to enable surgery and reduce the risk of recurrence.

Results were highly encouraging: 80% of patients experienced tumour shrinkage, and several who were initially inoperable became eligible for surgery after treatment. The combination achieved a median overall survival of 22.5 months, with manageable side effects.

Key takeaway: The toripalimab, lenvatinib, and GEMOX combination shows strong potential as a pre-surgery treatment for bile duct cancer. It may help more patients become eligible for curative surgery while maintaining good long-term outcomes and manageable side effects.

4. Dual Immune Checkpoint Blockade in Advanced Bile Duct Cancer – IMMUNOBIL Trial

The IMMUNOBIL trial evaluated dual immunotherapy using durvalumab and tremelimumab for patients with advanced biliary tract cancer (BTC) whose disease had progressed after chemotherapy. Both medicines work through different mechanisms to help the immune system recognise and attack cancer cells.

The treatment combination was well tolerated but produced modest benefits: around 10% of patients experienced a measurable tumour response, and average overall survival was about 8 months. Adding chemotherapy to the combination caused unacceptable side effects and was discontinued early.

Key takeaway: Dual immunotherapy with durvalumab and tremelimumab was safe but offered limited benefit for advanced bile duct cancer after chemotherapy. Future research will aim to identify more effective combinations and determine which patients are most likely to respond.

Author:

Natasha Muench