Efficacy and safety of atezolizumab plus bevacizumab in Korean patients with advanced hepatocellular carcinoma

Abstract

Background & Aims: Atezolizumab plus bevacizumab (Ate/Bev) has demonstrated efficacy and safety in patients with advanced hepatocellular carcinoma (HCC) in the phase III trial. Further evaluation is necessary to investigate the safety and efficacy of Ate/Bev in real settings. Methods:This was a multicentre retrospective analysis. Between May 2020 and February 2021, 138 patients received Ate/Bev as first-line treatment for advanced HCC from 11 institutions. We excluded patients with Child-Pugh B or C and BCLC D stage, and the remaining 121 patients were included in this analysis.Results: According to RECIST 1.1, the objective response and disease control rates were 24.0% and 76.0%. The median follow-up duration was 5.9 months (95% confidence interval [CI], 5.4-6.4), the median progression-free survival (PFS) was 6.5 months (95% CI, 4.1-9.0), and median overall survival (OS) was not reached (95% | INTRODUC TI ONPrimary liver cancer is the third leading cause of cancer-related death, and hepatocellular carcinoma (HCC) is the most common type of primary liver cancer, accounting for approximately 90% of cases. 1 Many patients are diagnosed at an advanced stage, and systemic therapy is the mainstay of treatment in patients with advancedstage HCC. Sorafenib was the first established drug as a standard first-line systemic treatment; however, there has been very limited progress in the treatment of advanced HCC since 2008. 2 Recently, in the phase III IMbrave 150 trial, the combination of atezolizumab and bevacizumab (Ate/Bev) showed significant improvement in overall survival (OS) vs sorafenib as first-line systemic treatment in patients with unresectable HCC, with median OS of 19.2 months, median progression-free survival (PFS) of 6.9 months and objective response rate (ORR) of 29.8%. 3,4 Based on the phase III study results, current international guidelines recommend Ate/ Bev as the first-line systemic therapy for patients with advanced HCC, and this combination treatment has been positioned as firstline treatment. [5][6][7] Despite positive clinical trial results, further evaluation of realworld data is warranted due to discrepancies in patient characteristics between clinical trials and daily practice. Therefore, the Korean Cancer Study Group (KCSG) performed a multicentre retrospective analysis to evaluate the efficacy and safety of Ate/Bev as a first-line treatment in Korean patients with advanced HCC.

Pretreatment Positron Emission Tomography with ¹⁸F-Fluorodeoxyglucose May Be a Useful New Predictor of Early Progressive Disease following Atezolizumab plus Bevacizumab in Patients with Unresectable Hepatocellular Carcinoma

“…This difference may have been due to the small number of cases in the current study. In addition, it should be noted that previously reported NLR cut-off values for predicting patient outcomes differ between studies [15, 43-45], and NLRs change due to various patient conditions (e.g., infections and certain medications, particularly steroid-based immunosuppressive regimens). Therefore, more robust NLR cut-off values are desirable for use in daily clinical practice.…”

“…As in the previous reports [41,42], readministration of lenvatinib after diagnosed disease progression during immunotherapies has the potential of disease control effect in some patients. Recently, other researchers reported the utility of NLRs for predicting patient outcomes following Atezo/Bev treatment of HCC [15,[43][44][45]. Furthermore, Maesaka et al [15] reported an NLR cut-off value of ≥3 as a useful predictor for HPD.…”

Could We Predict the Response of Immune Checkpoint Inhibitor Treatment in Hepatocellular Carcinoma?

“…Since AFP level is related to the tumor or patient characteristics, interpretation should be performed with caution. As generally seen in other treatments, a decline in post-treatment tumor marker level is associated with better efficacy of immunotherapy in advanced HCC; the AFP response at 6 weeks after atezolizumab plus bevacizumab initiation especially seemed to be a potential surrogate biomarker for prognosis [43][44][45].…”

BTBD10 is a Prognostic Biomarker Correlated With Immune Infiltration in Hepatocellular Carcinoma

“…The high mortality and recurrence of hepatocellular carcinoma (HCC) made it the second leading cause of cancer-related death in the world ( Chen et al, 2016 ; Sung et al, 2021 ). Although current treatments for HCC, including interventional or radiofrequency ablation ( Pérez-Romasanta et al, 2021 ), chemotherapy or targeted therapy ( Cheon et al, 2021 ), surgical resection ( Gunasekaran et al, 2021 ), and liver transplantation ( Hughes and Humar, 2021 ), etc., exhibit respective therapeutic effect, the overall survival (OS) of HCC is still unsatisfied ( D'Avola et al, 2021 ). Therefore, there is an urgent need to explore new effective biomarkers and/or potential molecular targets for anti-tumor therapy to improve the treatment strategy of HCC patients with different pathological stages.…”