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atezolizumab + bevacizumab + pegargiminase is a combination therapy being evaluated for the treatment of locally advanced or metastatic hepatocellular carcinoma (HCC). The regimen consists of pegargiminase (ADI-PEG 20), a pegylated recombinant arginine deiminase that depletes systemic arginine to starve argininosuccinate synthetase 1 (ASS1)-deficient tumor cells; atezolizumab, a monoclonal antibody targeting programmed cell death 1 ligand 1 (PD-L1) to restore anti-tumor T-cell activity; and bevacizumab, a monoclonal antibody targeting vascular endothelial growth factor A (VEGF-A) to inhibit tumor angiogenesis. This triplet combination is being investigated in clinical trials, notably at the M.D. Anderson Cancer Center, to determine if the metabolic stress induced by arginine depletion can synergize with immune checkpoint blockade and anti-angiogenic therapy to improve clinical outcomes in patients with advanced liver cancer.
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