Safety and Feasibility of Combining On-Demand Selective Locoregional Treatment with First-Line Atezolizumab Plus Bevacizumab for Patients with Unresectable Hepatocellular Carcinoma

Abstract

Various locoregional treatments for localized hepatocellular carcinoma (HCC) have been developed. This retrospective study investigated the safety and feasibility of combining on-demand selective locoregional treatment for residual lesions after tumor shrinkage (complete response [CR] oriented) or for solitary or few drug-resistant lesions (progressive disease (PD) salvage) with first-line atezolizumab plus bevacizumab (atezo/bev) for unresectable HCC. Twenty-nine patients with unresectable HCC were included. Fourteen locoregional treatments were performed (CR oriented, 7; PD salvage, 7) in ten patients in the combination-therapy group. All patients in the combination-therapy group successfully achieved a CR or PD salvage status after the planned locoregional treatment. The objective response rate of the combination-therapy group (80.0%) was higher than that of the atezo/bev alone group (21.1%; p = 0.005). Progression-free survival (PFS) and overall survival (OS) were longer in the combination group (medians for PFS and OS not reached) than in the atezo/bev alone group (median PFS, 7.4 months; median OS, 19.8 months) (PFS, p = 0.004; OS, p < 0.001). The albumin-bilirubin score did not change, and no severe complications occurred after locoregional treatment. When performed in a minimally invasive manner, on-demand selective locoregional treatment combined with first-line atezo/bev could be safe and feasible for unresectable HCC.

Keywords: atezolizumab plus bevacizumab; combination therapy; hepatocellular carcinoma; locoregional treatment; radiofrequency ablation; stereotactic body radiotherapy; surgical resection; transarterial chemoembolization.

Figure 1

Comparisons of the combination-therapy and atezolizumab plus bevacizumab alone groups in terms of (A) PFS and (B) OS. Atezo/Bev, atezolizumab plus bevacizumab; PFS, progression-free survival; OS, overall survival.

Figure 2

Changes in the ALBI scores in both pre- and post-locoregional treatment. The median ALBI scores at baseline (initiation of atezolizumab plus bevacizumab), before locoregional treatment, and at 1 month and 3 months after locoregional treatment were −2.743, −2.606, −2.763, and −2.604, respectively. ALBI, albumin–bilirubin.