Efficacy, Safety, and Patient-Reported Outcomes of Atezolizumab Plus Bevacizumab for Unresectable Hepatocellular Carcinoma in Thailand: A Multicenter Prospective Study

Abstract

Purpose: Atezolizumab plus bevacizumab treatment is a first-line therapy for unresectable hepatocellular carcinoma (HCC) worldwide. The efficacy, safety, and patient-reported outcomes (PROs) of HCC in Thailand have not yet been reported. This study aimed to evaluate the efficacy, safety, and PROs of atezolizumab plus bevacizumab.

Materials and methods: From September 2020 to August 2021, 30 patients with unresectable HCC who met the inclusion criteria of atezolizumab plus bevacizumab as first-line treatment were enrolled. Analysis was assessed for progression-free survival, overall survival, adverse events (AEs), and quality of life (QoL).

Results: The median progression-free survival and overall survival periods were 6.7 and 10.2 months, respectively. The disease control rate was 63.3%. The frequent AEs were proteinuria, hypertension, and hepatitis. Serious AEs included gastrointestinal bleeding, but none of the patients died from serious AEs. The discontinuation rate was 23.3%, and the median number of treatment cycles was 10.5 cycles. In total, 23.3% of the patients continued treatment after 1 year of therapy. The global health status/QoL and physical function scores showed less deterioration at baseline than at 3 and 6 months (median scores = 76.7, 71.6, and 64.1 in QoL and 84.7, 79.6, and 79.0 in physical function, respectively). The HCC18 symptom score index data showed a slow progression of symptom scores from baseline to 3 and 6 months (12.7, 19.6, and 22.3, respectively).

Conclusion: This study demonstrates that atezolizumab plus bevacizumab is effective and has a safety profile comparable with that of previous studies as first-line therapy for unresectable HCC in a real-world setting and in Thai populations. Data on PROs also demonstrate benefits in terms of patients' QoL and symptoms.

FIG 1

(A) OS and (B) PFS curves of the patients treated with atezolizumab plus bevacizumab. OS, overall survival; PFS, progression-free survival.

FIG 2

Assessment of the overall response rate using the Response Evaluation Criteria in Solid Tumors. PD, progressive disease; PR, partial response; SD, stable disease.

FIG 3

(A) The global health status/QoL and (B) physical function score based on the EORTC-QLC C30 and (C) HCC symptoms score index using the EORTC-QLQ-HCC18 at baseline, 3, 6, 9, and 12 months of atezolizumab and bevacizumab treatment. EORTC-QLC C30, European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire; HCC, hepatocellular carcinoma; QoL, quality of life.