Atezolizumab plus bevacizumab in patients with child-Pugh B advanced hepatocellular carcinoma

Jaekyung Cheon; Hyeyeong Kim; Han Sang Kim; Chang Gon Kim; Ilhwan Kim; Beodeul Kang; Chan Kim; Sanghoon Jung; Yeonjung Ha; Hong Jae Chon

doi:10.1177/17588359221148541

Atezolizumab plus bevacizumab in patients with child-Pugh B advanced hepatocellular carcinoma

Ther Adv Med Oncol. 2023 Jan 12:15:17588359221148541. doi: 10.1177/17588359221148541. eCollection 2023.

Authors

Jaekyung Cheon¹, Hyeyeong Kim², Han Sang Kim³, Chang Gon Kim³, Ilhwan Kim⁴, Beodeul Kang¹, Chan Kim¹, Sanghoon Jung⁵, Yeonjung Ha⁶, Hong Jae Chon⁷

Affiliations

¹ Department of Medical Oncology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea.
² Department of Hematology-Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea.
³ Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea.
⁴ Department of Oncology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea.
⁵ Department Radiology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea.
⁶ Department of Gastroenterology, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam 13496, South Korea.
⁷ Department of Medical Oncology, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam 13496, South Korea.

Abstract

Background: Atezolizumab plus bevacizumab (Ate/Bev) demonstrated promising efficacy and safety in patients with advanced hepatocellular carcinoma (HCC) in the phase III IMbrave150 trial. However, patients with Child-Pugh B HCC were excluded in the abovementioned prospective trial. Therefore, we aimed to investigate the efficacy and safety of Ate/Bev in patients with Child-Pugh B HCC.

Methods: This multicenter retrospective study included 36 patients with Child-Pugh B advanced HCC who received Ate/Bev at four cancer referral centers between May 2020 and August 2021. Comparative analyses were performed with an independent cohort of patients with Child-Pugh A HCC from the same registry (n = 133).

Results: All patients received Ate/Bev as first-line systemic treatment for advanced HCC. The objective response and disease control rates of patients in the Child-Pugh groups B and A were 11.1% and 58.3% and 34.6% and 76.7%, respectively. The median progression-free survival (PFS) and overall survival (OS) were 3.0 months [95% confidence interval (CI), 1.7-4.3) and 7.7 months (95% CI, 4.8-10.6) in the Child-Pugh B group, whereas the median PFS and OS were 9.6 months (95% CI, 5.1-14.2) and not reached (95% CI, not available) in the Child-Pugh A group, respectively. Compared to the Child-Pugh A group, grade 3-4 adverse events (AEs) were more common in the Child-Pugh B group (44.4% versus 15.8, p < 0.001), with the most frequent grade 3-4 AEs being gastrointestinal bleeding (n = 6, 16.7%), neutropenia (n = 5, 13.9%), and thrombocytopenia (n = 4, 11.1%).

Conclusions: In the Child-Pugh B subgroup of patients with advanced HCC, Ate/Bev treatment showed modest clinical activity. However, due to the increased frequency of serious AEs, careful evaluation of treatment response and AE management is required in this subgroup of patients.

Keywords: atezolizumab; bevacizumab; child–Pugh B; hepatocellular carcinoma; systemic treatment.