Management of portal hypertension in patients treated with atezolizumab and bevacizumab for hepatocellular carcinoma

Ollivier-Hourmand, Isabelle; Allaire, Manon; Cervoni, Jean Paul

doi:10.1016/j.jhep.2022.02.004

Cited by 11 publications

(15 citation statements)

References 9 publications

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“…NSBBs are preferred as they are more adapted to HCC treatment plan. However, in case of NSBB contraindication or intolerance, EBL can be performed, and it seems reasonable to start bevacizumab after at least one session of EBL 49 …”

Section: Liver Function Deteriorationmentioning

confidence: 99%

“…49 Therefore, before starting bevacizumab or any other anti-angiogenic treatment, upper endoscopy should be systematically performed. 49 If grade ≥2 oesophageal varices are present, primary prophylaxis with non-selective beta-blockers (NSBBs) or endoscopic band ligation (EBL) is recommended. 48 NSBBs are preferred as they are more adapted to HCC treatment plan.…”

Section: Atezolizumab Plus Bevacizumab-related Bleeding Riskmentioning

confidence: 99%

“…However, in case of NSBB contraindication or intolerance, EBL can be performed, and it seems reasonable to start bevacizumab after at least one session of EBL. 49 With optimal management, the presence of varices should not (1) IMbrave150 phase III study. 4,5 (2) HIMALAYA phase III study.…”

Section: Atezolizumab Plus Bevacizumab-related Bleeding Riskmentioning

confidence: 99%

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Immunotherapy in hepatocellular carcinoma: How does underlying liver disease influence therapeutic strategy and outcomes?

Roth

Villeret

Decaens

et al. 2023

Liver International

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Hepatocellular carcinoma (HCC) is the third leading cause of cancer death worldwide, with up to 90% of HCC cases occurring in the setting of underlying cirrhosis. Therapeutic landscape for advanced HCC has dramatically changed in recent years with the advent of immunotherapy, including several combinations. Data suggest that the surrounding liver milieu may influence tumour response. In addition, different aetiologies of HCC and their effects on the host liver may impact response to immunotherapy. However, to date, guidelines do not take into account this parameter to guide therapeutic selection, and phase III trials are likewise performed in patients irrespective of HCC aetiology. Moreover, most clinical trial data are collected in highly selected patients with preserved liver function (defined as Child‐Pugh class A) and controlled portal hypertension, which does not accurately reflect routine clinical practice. In this review, we discuss the influence of liver disease aetiology on the response to immunotherapy in patients with advanced HCC. We also discuss the safety and efficacy of various immunotherapeutic agents in Child‐Pugh B patients to determine if these treatments are beneficial in this vulnerable patient population.

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Section: Liver Function Deteriorationmentioning

confidence: 99%

Section: Atezolizumab Plus Bevacizumab-related Bleeding Riskmentioning

confidence: 99%

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Immunotherapy in hepatocellular carcinoma: How does underlying liver disease influence therapeutic strategy and outcomes?

Roth

Villeret

Decaens

et al. 2023

Liver International

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“… 55 Thus, this treatment may expose patients to bleeding complications related to portal hypertension, or related to anticoagulant therapy. 57 This poses new challenges with respect to the choice of first‐line therapy, especially since the best method for bleeding prevention and risk stratification (e.g. according to the grade of varices or the presence of red signs) remain unknown.…”

Section: Advanced Stage Hepatocellular Carcinoma (Barcelona Clinic Li...mentioning

confidence: 99%

“…Upper gastrointestinal bleeding occurred more frequently with the combination than with Sorafenib (7% vs. 4.5%) 55 . Thus, this treatment may expose patients to bleeding complications related to portal hypertension, or related to anticoagulant therapy 57 . This poses new challenges with respect to the choice of first‐line therapy, especially since the best method for bleeding prevention and risk stratification (e.g.…”

Section: Advanced Stage Hepatocellular Carcinoma (Barcelona Clinic Li...mentioning

confidence: 99%

New concepts in the treatment of hepatocellular carcinoma

2022

Self Cite

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Hepatocellular carcinoma (HCC) is the third most common cause of cancer-related death and occurs mainly in the context of chronic liver disease at cirrhosis stage.The Barcelona Clinic Liver Cancer classification, first established in 1999, is the most commonly used staging system for HCC in Western countries that link tumor burden, liver function and performance status with prognosis and therapeutic management. Since the first publication of this classification, it has been implemented in several clinical guidelines and recent major therapeutic advances in the management of HCC have modified the therapeutic landscape of HCC. Accordingly, an updated version was recently published in 2022, incorporating an expert clinical decision-making component and the concept of treatment stage migration. This update also introduces the positive results of recent randomized clinical trials, and introduces atezolizumab/bevacizumab (A/B) as a first-line combination regimen for patients with advanced HCC. Finally, the complexity of the management of patients with HCC highlights the need for a multidisciplinary approach including input from hepatology, surgery, radiology, medical oncology, and radiation oncology.

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Clinical risk factors for portal hypertension-related complications in systemic therapy for hepatocellular carcinoma

Fujiwara,

Kondo,

Fujimoto

et al. 2024

J Gastroenterol

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Background During systemic therapy, the management of portal hypertension (PH)-related complications is vital. This study aimed to clarify factors associated with the incidence and exacerbation of PH-related complications, including the usefulness of contrast-enhanced computed tomography (CECT) in the management of PH-related complications during systemic therapy. Methods A total of 669 patients who received systemic therapy as first-line treatment (443 patients for sorafenib, 131 for lenvatinib, and 90 for atezolizumab/bevacizumab [ATZ/BEV]) were enrolled in this retrospective study. Additionally, the lower esophageal intramural vessel diameters (EIV) on CECT and endoscopic findings in 358 patients were compared. Results The cutoff values of the EIV diameter on CECT were 3.1 mm for small, 5.1 mm for medium, and 7.6 mm for large varices, demonstrating high concordance with the endoscopic findings. esophageal varices (EV) bleeding predictors include EIV ≥ 3.1 mm and portal vein tumor thrombosis (PVTT). In patients without EV before systemic therapy, factors associated with EV exacerbation after 3 months were EIV ≥ 1.9 mm and ATZ/BEV use. Predictors of hepatic encephalopathy (HE) include the ammonia level or portosystemic shunt diameter ≥ 6.8 mm. The incidence of HE within 2 weeks was significantly higher (18%) in patients with an ammonia level ≥ 73 μmol/L and a portosystemic shunt ≥ 6.8 mm. The exacerbating factors for ascites after 3 months were PVTT and low albumin levels. Conclusions Careful management is warranted for patients with risk factors for exacerbation of PH-related complications; moreover, the effective use of CECT is clinically important.

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Management of portal hypertension in patients treated with atezolizumab and bevacizumab for hepatocellular carcinoma

Cited by 11 publications

References 9 publications

Immunotherapy in hepatocellular carcinoma: How does underlying liver disease influence therapeutic strategy and outcomes?

Immunotherapy in hepatocellular carcinoma: How does underlying liver disease influence therapeutic strategy and outcomes?

New concepts in the treatment of hepatocellular carcinoma

Clinical risk factors for portal hypertension-related complications in systemic therapy for hepatocellular carcinoma

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