Estimation of the effect of atezolizumab plus bevacizumab on pulmonary arterial hypertension using computed tomography in HCC patients

Abstract

The effect of the combination of atezolizumab and bevacizumab (Atez/Bev) for hepatocellular carcinoma (HCC) on pulmonary arterial hypertension (PAH) is unknown. Estimation of PAH by using computed tomography (CT) has recently been proposed. Thus, we aimed to estimate the effect of Atez/Bev on PAH using CT. Altogether, 113 patients who received Atez/Bev for HCC were enrolled. Probable PAH was defined as the diameter of the main pulmonary artery (mPA-D) ≥ 33 mm, whereas suspicious PAH was defined as mPA-D ≥ 29 mm or mPA-D/the diameter of the ascending aorta (aAo-D) ≥ 1.0. Before treatment, probable/suspicious PAH were diagnosed in 7 (6.7%)/22 (21.0%) patients, respectively. mPA-D and mPA-D/aAo-D significantly increased after induction of Atez/Bev. The increment of mPA-D was correlated with the occurrence of post-treatment respiratory/heart failure. In analysis of 55 patients who underwent CT at 3 months after the last dose of Atez/Bev, mPA-D and mPA-D/aAo-D significantly decreased. However, in the group with continuous treatment of other molecular-targeted drugs after Atez/Bev, mPA-D and mPA-D/aAo-D showed no significant change. In conclusion, PAH may not be a rare complication in patients with HCC and should be managed carefully because of the possible negative effect of Atez/Bev on PAH.

Cancer Therapy-Associated Pulmonary Hypertension and Right Ventricular Dysfunction: Etiologies and Prognostic Implications

“…In a study of 59 patients with lung cancer treated with nivolumab, there was an increase of pulmonary artery to aorta diameter, a marker of PH, on computed tomography (CT) imaging from 0.82 to 0.87 ( p 0.001) [ 90 ]. Similarly, in a study of 117 of patients with hepatocellular carcinoma treated with atezolizumab (an ICI) and bevacizumab (anti-vascular endothelial growth factor (VEGF) monoclonal antibody), there was an increase in mean pulmonary artery diameter to aorta ratio on CT imaging after treatment (0.76 vs 0.79 mm, p 0.001) [ 91 ].…”

“…Cancer therapies associated with PH and potential mechanisms of action are summarized in Table 2 (Ref. [ 35 , 40 , 41 , 48 , 65 , 66 , 67 , 73 , 91 ]).…”