Roche’s combination of Tecentriq with Avastin in the first-line hepatocellular cancer trial Imbrave-150 has allowed the Swiss group to succeed where Bristol-Myers Squibb failed. This is an important consideration as Roche fights to make Avastin the go-to half of an immunotherapy combo, and to keep this franchise relevant with doctors. While Bristol’s failed Checkmate-459 trial of Opdivo in the same setting has been criticised for enrolling a PD-L1-unselected population, Roche looks to have scored a resounding success in Imbrave-150, despite also not selecting PD-L1-positive subjects. That said, when the data were presented at a late-breaking session of the Esmo-Asia conference over the weekend no mention was made of PD-L1 positivity, so it is unclear to what extent PD-L1-positives might have driven the all-comers benefit. And it will not go unnoticed that 4.3 months of median progression-free survival for Imbrave-150’s Nexavar control cohort underperformed the 5.5 months cited on Nexavar’s US label. Nevertheless, Tecentriq plus Avastin now looks highly likely to become the first immunotherapy approved for first-line liver cancer, and to make life hard for the approved second-line agents Opdivo and Merck & Co’s Keytruda.