Clinical Outcomes of Ramucirumab as Post-treatment Following Atezolizumab/Bevacizumab Combination Therapy in Advanced Hepatocellular Carcinoma

Abstract

Aim: The present study evaluated the efficacy and safety of ramucirumab (RAM) in clinical practice as post-treatment, following atezolizumab plus bevacizumab (Atz/Bev) for advanced hepatocellular carcinoma (HCC) with alpha-fetoprotein (AFP) levels of ≥400 ng/ml.

Patients and methods: Of the 77 patients treated with Atz/Bev at our institution, 13 patients for whom RAM was introduced as post-treatment following Atz/Bev were enrolled in this retrospective study. There were 9 patients (69.2%) with Child-Pugh A and 11 patients (84.6%) for whom RAM was initiated as 3^rd- or later-line therapy. The median AFP level was 2259 ng/ml.

Results: The objective response rate by Response Evaluation Criteria in Solid Tumours at 6 weeks was 15.4%, and the disease control rate was 69.2%. The median time to progression was 3.0 months; AFP level decreased at 2 weeks in 11 patients (84.6%) and at 6 weeks in seven patients (53.8%). The most common adverse events (AEs) within 6 weeks were ascites, peripheral oedema, and proteinuria, while grade 3 AEs occurred in six patients (46.2%). Albumin-bilirubin scores at both 4 and 6 weeks were significantly worse than those at baseline.

Conclusion: In HCC patients with AFP levels of ≥400 ng/mL, RAM after Atz/Bev is expected to be an effective treatment option. Careful attention should be paid to the development of AEs and deterioration of liver function, especially when RAM is used as 3^rd- or later-line therapy. Additional studies are needed to confirm the efficacy and safety of RAM as 2^nd-line treatment after Atz/Bev in Child-Pugh A patients.

Keywords: Alpha fetoprotein; atezolizumab plus bevacizumab; hepatocellular carcinoma; post-treatment; ramucirumab.