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. 2023 Jun;149(6):2345-2354.
doi: 10.1007/s00432-023-04590-9. Epub 2023 Mar 2.

Outcomes of hepatocellular carcinoma by etiology with first-line atezolizumab and bevacizumab: a real-world analysis

Affiliations

Outcomes of hepatocellular carcinoma by etiology with first-line atezolizumab and bevacizumab: a real-world analysis

Timothy J Brown et al. J Cancer Res Clin Oncol. 2023 Jun.

Abstract

Purpose: Hepatocellular carcinoma (HCC) is a common and deadly form of liver cancer. Combination atezolizumab and bevacizumab has improved the outcomes for patients with advanced disease. We sought to determine the impact of etiology on outcomes of patients treated with atezolizumab and bevacizumab.

Methods: This study used a real-world database. The primary outcome was overall survival (OS) by etiology of HCC; the secondary outcome was real-world time to treatment discontinuation (rwTTD). Time-to-event analyses was performed by the Kaplan-Meier method; the log-rank test to assess for differences by etiology from date of first receipt of atezolizumab and bevacizumab. The Cox proportional hazards model was used to calculate hazard ratios.

Results: In total, 429 patients were included (n = 216 Viral-HCC; n = 68 Alcohol-HCC; n = 145, NASH-HCC). The median overall survival for the entire cohort was 9.4 months (95% CI 7.1-10.9). Compared with Viral-HCC, the hazard ratio (HR) of death was 1.11 (95% CI 0.74-1.68, p = 0.62) for Alcohol-HCC and was 1.34 (95% CI 0.96-1.86, p = 0.08) for NASH-HCC. The median rwTTD for the entire cohort was 5.7 months (95% CI 5.0-7.0 months). The HR of rwTTD was 1.24 (95% CI 0.86-1.77, p = 0.25) for Alcohol-HCC and was 1.31 (95% CI 0.98-1.75, p = 0.06) in reference to TTD with Viral-HCC.

Conclusions: In this real-world cohort of patients with HCC receiving first-line atezolizumab and bevacizumab, we did not identify an association between etiology and OS or rwTTD. This suggests that the efficacy of atezolizumab and bevacizumab may be similar across HCC etiologies. Further prospective studies are needed to confirm these findings.

Keywords: Hepatocellular carcinoma; Immunotherapy; NASH; Outcomes.

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Conflict of interest statement

The authors declare no competing interests.

The authors have not disclosed any competing interests.

Figures

Fig. 1
Fig. 1
Consort diagram for patients included in the primary analysis of overall survival. The initial cohort contained 8410 patients. Of these, 429 met the inclusion and exclusion criteria and were analyzed
Fig. 2
Fig. 2
Kaplan Meier curve for (A) overall survival and (B) real-world time to treatment discontinuation by etiology. No significant association was observed for either OS or rwTTD and etiology of HCC. HR hazard ratio, CI confidence interval, rwTTD real-world time to treatment discontinuation

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