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. 2024 Jul 5;29(7):e922-e931.
doi: 10.1093/oncolo/oyae048.

Concurrent Atezolizumab Plus Bevacizumab and High-Dose External Beam Radiotherapy for Highly Advanced Hepatocellular Carcinoma

Chung-Wei Su  1   2 , Wei Teng  1   2 , Eric Yi-Liang Shen  2   3   4 , Bing-Shen Huang  2   3 , Po-Ting Lin  1   2 , Ming-Mo Hou  2   5 , Tsung-Han Wu  2   6 , Din-Li Tsan  2   3 , Chia-Hsun Hsieh  2   5   7 , Ching-Ting Wang  2   8 , Pei-Mei Chai  2   8 , Chun-Yen Lin  1   2 , Shi-Ming Lin  1   2 , Chen-Chun Lin  2   9
Affiliations

Concurrent Atezolizumab Plus Bevacizumab and High-Dose External Beam Radiotherapy for Highly Advanced Hepatocellular Carcinoma

Chung-Wei Su et al. Oncologist. .

Abstract

Background: Atezolizumab plus bevacizumab (atezo-bev) has been recommended for advanced hepatocellular carcinoma (HCC). High-dose external beam radiotherapy (RT) is recognized for its excellent local tumor control. The efficacy and safety of concurrent atezo-bev with RT for highly advanced HCC has been minimally explored.

Methods: In this preliminary retrospective study, we assessed patients with highly advanced HCC, characterized by Vp4 portal vein thrombosis or tumors exceeding 50% of liver volume, who received concurrent atezo-bev and RT (group A). Group A included 13 patients who received proton radiation at a dose of 72.6 GyE in 22 fractions, and one patient who received photon radiation at a dose of 54 Gy in 18 fractions. This group was compared with 34 similar patients treated atezo-bev alone as a control (group B). The primary objectives were to evaluate the objective response rate (ORR), overall survival (OS), and safety.

Results: Baseline characteristics were similar between groups, except for a higher incidence of Vp4 portal vein thrombosis in group A (78.6% vs. 21.4%, P = .05). Group A achieved a higher ORR (50.0% vs. 11.8%, P < .01) and a longer OS (not reached vs. 5.5 months, P = .01) after a median follow-up of 5.2 months. Multivariate analysis indicated that concurrent RT independently favored longer OS (hazard ratio: 0.18; 95% CI, 0.05-0.63, P < .01). Group A did not increase any grade adverse events (78.6% vs. 58.8%, P = .19) or severe adverse events of grade ≥ 3 (14.3% vs. 14.7%, P = .97) compared to group B.

Conclusions: The concurrent high-dose external beam radiotherapy appears to safely enhance the effectiveness of atezolizumab plus bevacizumab for highly advanced patients with HCC. Further studies are warranted to confirm these findings.

Keywords: atezolizumab plus bevacizumab; hepatocellular carcinoma; portal vein thrombosis; radiotherapy; toxicity.

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Conflict of interest statement

The authors indicated no financial relationships.

Figures

Figure 1.
Figure 1.
Kaplan-Meier failure function of time to progression for highly advanced patients received atezo-bev. (a) Intrahepatic tumor growth, (b) new intrahepatic tumor, (c) extrahepatic tumor growth, and (d) new extrahepatic tumor growth. atezo-bev, atezolizumab plus bevacizumab; RT, external beam radiation therapy.
Figure 2.
Figure 2.
Kaplan-Meier survival function for highly advanced patients received atezo-bev. (a) OS for overall patients, (b) PFS for overall patients, (c) OS for atezo-bev as first-line therapy patients, and (d) PFS for atezo-bev as first-line therapy patients. atezo-bev, atezolizumab plus bevacizumab; RT, external beam radiation therapy; OS, overall survival; PFS, progression-free survival.
Figure 3.
Figure 3.
Kaplan-Meier failure function of time to ALBI grade 3 for highly advanced patients received atezo-bev. ALBI, albumin-bilirubin index; atezo-bev, atezolizumab plus bevacizumab; RT, external beam radiation therapy.
See this image and copyright information in PMC

References

    1. Rumgay H, Arnold M, Ferlay J, et al.. Global burden of primary liver cancer in 2020 and predictions to 2040. J Hepatol. 2022;77(6):1598-1606. 10.1016/j.jhep.2022.08.021 - DOI - PMC - PubMed
    1. Reig M, Forner A, Rimola J, et al.. BCLC strategy for prognosis prediction and treatment recommendation: The 2022 update. J Hepatol. 2022;76(3):681-693. 10.1016/j.jhep.2021.11.018 - DOI - PMC - PubMed
    1. Tandon P, Garcia-Tsao G.. Prognostic indicators in hepatocellular carcinoma: a systematic review of 72 studies. Liver Int. 2009;29(4):502-510. 10.1111/j.1478-3231.2008.01957.x - DOI - PMC - PubMed
    1. Finn RS, Qin S, Ikeda M, et al.. Abstract CT009: IMbrave150: Updated efficacy and safety by risk status in patients (pts) receiving atezolizumab (atezo) + bevacizumab (bev) vs sorafenib (sor) as first-line treatment for unresectable hepatocellular carcinoma (HCC). Cancer Res. 2021;81(13_Supplement):CT009-CT009. 10.1158/1538-7445.am2021-ct009 - DOI
    1. Gkika E, Schultheiss M, Bettinger D, et al.. Excellent local control and tolerance profile after stereotactic body radiotherapy of advanced hepatocellular carcinoma. Radiat Oncol. 2017;12(1):116. 10.1186/s13014-017-0851-7 - DOI - PMC - PubMed

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