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Observational Study
. 2022 Feb;5(2):e1464.
doi: 10.1002/cnr2.1464. Epub 2021 Jun 11.

Atezolizumab plus bevacizumab treatment for unresectable hepatocellular carcinoma: Early clinical experience

Atsushi Hiraoka  1 , Takashi Kumada  2 , Toshifumi Tada  3 , Masashi Hirooka  4 , Kazuya Kariyama  5 , Joji Tani  6 , Masanori Atsukawa  7 , Koichi Takaguchi  8 , Ei Itobayashi  9 , Shinya Fukunishi  10 , Kunihiko Tsuji  11 , Toru Ishikawa  12 , Kazuto Tajiri  13 , Hironori Ochi  14 , Satoshi Yasuda  15 , Hidenori Toyoda  15 , Chikara Ogawa  16 , Takashi Nishimura  17 , Takeshi Hatanaka  18 , Hideko Ohama  10 , Kazuhiro Nouso  5 , Asahiro Morishita  6 , Akemi Tsutsui  8 , Takuya Nagano  8 , Norio Itokawa  7 , Tomomi Okubo  7 , Taeang Arai  7 , Michitaka Imai  12 , Yohei Koizumi  4 , Shinichiro Nakamura  3 , Kouji Joko  14 , Hiroko Iijima  17 , Yoichi Hiasa  4 , Masatoshi Kudo  19 ; Real-life Practice Experts for HCC (RELPEC) Study Group, and HCC 48 Group (Hepatocellular Carcinoma Experts from 48 Clinics in Japan)
Affiliations
Observational Study

Atezolizumab plus bevacizumab treatment for unresectable hepatocellular carcinoma: Early clinical experience

Atsushi Hiraoka et al. Cancer Rep (Hoboken). 2022 Feb.

Abstract

Background: Although atezolizumab plus bevacizumab (Atez/bev) treatment has been developed for unresectable hepatocellular carcinoma (u-HCC), changes in hepatic function during therapy have yet to be reported.

Aim: This retrospective clinical study aimed to elucidate early responses to Atez/Bev.

Methods: From September 2020 to April 2021, 171 u-HCC patients undergoing Atez/Bev treatment were enrolled (BCLC stage A:B:C:D = 5:68:96:2). Of those, 75 had no prior history of systemic treatment. Relative changes in hepatic function and therapeutic response were assessed using albumin-bilirubin (ALBI) score and Response Evaluation Criteria in Solid Tumors (RECIST), ver. 1.1, respectively.

Results: In initial imaging examination findings, objective response rates for early tumor shrinkage and disease control after 6 weeks (ORR-6W/DCR-6W) were 10.6%/79.6%. Similar response results were observed in patients with and without a past history of systemic treatment (ORR-6W/DCR-6W = 9.7%/77.8% and 12.2%/82.9%), as well as patients in whom Atez/Bev was used as post-progression treatment following lenvatinib (ORR-6W/DCR-6W = 7.7%/79.5%), for which no known effective post-progression treatment has been established. In 111 patients who underwent a 6-week observation period, ALBI score was significantly worsened at 3 weeks after introducing Atez/Bev (-2.525 ± 0.419 vs -2.323 ± 0.445, p < .001), but then recovered at 6-weeks (-2.403 ± 0.452) as compared to 3-weeks (p = .001). During the observation period, the most common adverse events were appetite loss (all grades) (12.3%), general fatigue/hypertension (all grades) (11.1%, respectively), and urine protein (all grades) (10.5%).

Conclusion: Atez/Bev might have therapeutic potential not only as first but also later-line treatment of existing molecular target agents. In addition, this drug combination may have less influence on hepatic function during the early period, as the present patients showed a good initial therapeutic response.

Keywords: albumin-bilirubin score; atezolizumab plus bevacizumab; hepatic function; lenvatinib; unrespectable hepatocellular carcinoma.

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Conflict of interest statement

Atsushi Hiraoka, MD, PhD: lecture fees; Bayer, Eisai, Eli Lilly, Otsuka.

Takashi Kumada, MD, PhD: lecture fees; Eisai.

Masatoshi Kudo, MD, PhD: Advisory role: Eiasi, Ono, MSD, Bristol‐Myers Squibb, Roche. Lecture fees; Eisai, Bayer, MSD, Bristol‐Myers Squibb, Eli Lilly, EA Pharma. Research funding; Gilead Sciences, Taiho, Sumitomo Dainippon Pharma, Takeda, Otsuka, EA Pharma, Abbvie, Eisai.

The authors have stated explicitly that there are no conflicts of interest in connection with this article.

Figures

FIGURE 1
FIGURE 1
Relative changes in (A) Child‐Pugh score and (B) modified ALBI grade
FIGURE 2
FIGURE 2
Patients who underwent observations after 6 weeks (n = 111). Relative changes in ALBI score for (A) all 111 patients (baseline, −2.525 ± 0.419; 3 weeks, −2.323 ± 0.445; 6 weeks, −2.403 ± 0.452), (B) 111 patients divided by mALBI grade, (C) 111 patients divided by therapy (Atez/Bev as first‐line vs Atez/Bev as later‐line), and (D) 100 patients divided by therapeutic response (non‐PD vs PD) after exclusion of eleven patients whose imaging evaluation was slightly delayed or missing at 6 week of blood sampling. NS, not significant
See this image and copyright information in PMC

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