Organ‐specific responses to atezolizumab plus bevacizumab in advanced hepatocellular carcinoma: A multicentre, retrospective study

Abstract

Background and AimsAnti‐programmed death 1 (PD‐1) monotherapy triggers various responses by each organ. In advanced hepatocellular carcinoma (HCC), while extrahepatic lesions demonstrate objective response rates (ORR) of 20%–40%, only 10% of intrahepatic lesions respond. Although first‐line atezolizumab/bevacizumab has shown survival benefits in advanced HCC, organ‐specific responses remain unexplored. Therefore, we aimed to assess organ‐specific responses in patients with advanced HCC receiving atezolizumab/bevacizumab.MethodsThis retrospective, multicenter, observational study included patients who received first‐line atezolizumab/bevacizumab for advanced HCC. Patients with Child‐Pugh class A, measurable tumour lesions and serial imaging available for response evaluation were eligible.ResultsBetween May 2020 and June 2021, 131 patients (median age: 62) from three cancer referral institutions were included. Ninety‐one had hepatitis B (69.5%), 108 were at Barcelona clinic liver cancer stage C (82.4%), and 78 had extrahepatic metastasis (59.5%). After a median follow‐up of 10.1 months, median progression‐free survival was 6.8 months (95% confidence interval [CI], 4.6–9.2), median overall survival remained unreached (95% CI, range unavailable) and the ORR was 29.0%. Among 270 individual tumour lesions, the liver was the most commonly involved organ (n = 158). Atezolizumab/bevacizumab induced ORR of 27.8%, 42.2%, 29.1% and 21.0% for liver, lymph nodes, lungs and other sites, respectively. The organ‐specific response rate for intrahepatic tumours decreased with increasing size (35.6%: <5 cm, 15.0%: ≥ 5 cm).ConclusionsUnlike anti‐PD‐1 monotherapy, atezolizumab/bevacizumab demonstrated favourable responses in intrahepatic lesions, comparable to those in extrahepatic lesions, and may potentially overcome the immune‐tolerant hepatic microenvironment in patients with advanced HCC.