Early Tumor Response and Safety of Atezolizumab Plus Bevacizumab for Patients with Unresectable Hepatocellular Carcinoma in Real-World Practice

Abstract

The aim of this study was to investigate the early tumor response and safety of atezolizumab plus bevacizumab for patients with unresectable hepatocellular carcinoma in real-world practice. Forty patients with Child-Pugh class A liver function and eastern cooperative oncology group performance status 0 or 1 were enrolled. The objective response rate (ORR) at six weeks after the start of treatment, changes in α-fetoprotein (AFP) and des-γ-carboxyprothrombin, incidence of adverse events (AEs), and changes in albumin-bilirubin (ALBI) score and serum ammonia level, were evaluated. Among 40 patients, 24 had histories of prior molecular targeted agents (MTAs). The ORR was 22.5% based on mRECIST. Multivariate analysis showed that an AFP ratio <1.0 at three weeks (odds ratio 39.2, 95% confidence interval CI 2.37–649.0, p = 0.0103) was the only significant factor for predicting early response. There was no significant difference in the frequency of AEs between patients receiving first-line treatments and others. Fatigue, proteinuria, and ascites were more frequent in patients who experienced prior treatment. No decrease in ALBI score or increase in serum ammonia level was observed. Our study demonstrated that AFP may be useful in assessing early response and that this treatment is safe, including in patients with prior MTA treatments.

Comparison of atezolizumab plus bevacizumab and lenvatinib in terms of efficacy and safety as primary systemic chemotherapy for hepatocellular carcinoma

“…In the IMbrave150 trial, patients receiving atezolizumab plus bevacizumab had an ORR of 33.2% and a DCR of 72.3% according to mRECIST and the median PFS was 6.9 months 1,13 Similarly, in the present study, the Atezo + Beva group had an ORR of 43.8% and a DCR of 76.6% according to mRECIST, and the median PFS was 8.8 months. Some previous clinical studies have reported the early experience of atezolizumab plus bevacizumab therapy as primary systemic chemotherapy for HCC, with the ORRs reportedly ranging from 31.8% to 37.5% and the DCRs reportedly ranging from 81.3% to 94.5% according to mRECIST 14–17 . The DCRs in these clinical practice studies, and the ORR and the PFS in our study were slightly better than those from the IMbrave150 trial.…”

Efficacy and Safety of Atezolizumab and Bevacizumab in the Real-World Treatment of Advanced Hepatocellular Carcinoma: Experience from Four Tertiary Centers

“…Another group from Japan published real-world data concerning tumor response and safety for atezolizumab/bevacizumab in 40 patients with Child–Pugh A cirrhosis [ 17 ]. Twenty-four patients had a previous treatment experience with molecular agents (TKI).…”

Pretreatment Neutrophil-to-Lymphocyte Ratio as a Predictive Marker of Response to Atezolizumab Plus Bevacizumab for Hepatocellular Carcinoma

“…Several real-world clinical studies have shown that Atezo/Bev therapy has comparable safety profiles and efficacy, as observed in the IMbrave150 study [4,5]. However, the objective response rate (ORR) and disease control rate (DCR) reported for Atezo/Bev in the updated analysis of the IMbrave150 trial are 29.8% and 73.9%, respectively [6].…”