Journal
EUROPEAN JOURNAL OF CANCER
Volume 175, Issue -, Pages 204-213Publisher
ELSEVIER SCI LTD
DOI: 10.1016/j.ejca.2022.08.024
Keywords
Advanced HCC; Systemic treatment; First line; Atezolizumab; Bevacizumab
Categories
Funding
- National Institute for Health Research (NIHR) Imperial BRC
- European Association for the Study of the Liver (Andrew Burroughs Fellowship)
- Cancer Research UK [RCCPDB-Nov21/100008]
- NIHR Imperial BRC
- Bayer
- Roche
- NIH [R01 MD012565]
- National Research Foundation of Korea - Korea government [MSIT] [NRF-2020R1C1C1010722]
- Wellcome Trust Strategic Fund [PS3416]
- Associazione Italiana per la Ricerca sul Cancro (AIRC MFAG) [25697]
- NIHR Imperial Experimental Cancer Medicine Centre
- Imperial College BRC
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This study confirms the reproducible safety and efficacy of atezolizumab plus bevacizumab in routine clinical practice for patients with unresectable hepatocellular carcinoma. The presence of portal vein tumor thrombosis (PVTT) and higher ALBI grade are indicators of poorer survival in patients who meet the Child-Pugh-A criteria.
Background: IMbrave150 has established the superiority of atezolizumab plus bevacizumab over sorafenib in patients with unresectable hepatocellular carcinoma (HCC). Methods: We generated a prospectively maintained database including patients treated with atezolizumab plus bevacizumab for unresectable HCC across Europe, Asia and USA. Clinico-pathologic characteristics were assessed for their prognostic influence on overall survival (OS) and progression-free survival (PFS) in univariable and multivariate analyses. Overall response rate by RECIST v1.1 and treatment-related adverse events (TRAEs) per CTCAE v.5.0 were reported. Results: Out of 433 patients, 296 Child-Pugh A and ECOG performance status01 patients received atezolizumab plus bevacizumab in first line and were included. Patients were mostly male (82.7%), cirrhotic (75%) with history of viral hepatitis (65.9%). Overall, 68.9% had Barcelona Clinic Liver Cancer C-stage HCC with portal vein tumour thrombosis (PVTT, 35%) and extrahepatic spread (EHS, 51.7%). After a median follow-up of 10.0 months (95% confidence interval (CI): 9.4-10.4), median OS and PFS were 15.7 (95% CI: 14.5-NE) and 6.9 months (95% CI: 6.1-8.3), respectively. In the response-evaluable patients (n Z 273), overall response rate was 30.8%. Overall, 221 patients (74.6%) developed TRAEs, with 70 (23.6%) reporting grade 3 or higher TRAEs; 25 (8.4%) patients had bleeding events. OS was independently associated with baseline Albumin-bilirubin (ALBI) grade and PVTT. Shorter PFS was associated with AFP >= 400 ng/ml, worse ALBI and presence of EHS. Conclusion: This global observational study confirms the reproducible safety and efficacy of atezolizumab plus bevacizumab in routine clinical practice. Within Child-Pugh-A criteria, the presence of PVTT and higher ALBI grade identify patients with poorer survival. (c) 2022 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
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