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Comparative Study
. 2024 Nov;60(10):1361-1373.
doi: 10.1111/apt.18237. Epub 2024 Sep 4.

Predictive factors and survival outcome of conversion therapy for unresectable hepatocellular carcinoma patients receiving atezolizumab and bevacizumab: Comparative analysis of conversion, partial response and complete response patients

Takeshi Hatanaka  1 , Satoru Kakizaki  2   3 , Atsushi Hiraoka  4 , Toshifumi Tada  5 , Masashi Hirooka  6 , Kazuya Kariyama  7 , Joji Tani  8 , Masanori Atsukawa  9 , Koichi Takaguchi  10 , Ei Itobayashi  11 , Shinya Fukunishi  12 , Kunihiko Tsuji  13 , Toru Ishikawa  14 , Kazuto Tajiri  15 , Hidenori Toyoda  16 , Chikara Ogawa  17 , Hiroki Nishikawa  18 , Takashi Nishimura  12 , Kazuhito Kawata  19 , Hisashi Kosaka  20 , Atsushi Naganuma  21 , Yutaka Yata  22 , Hideko Ohama  23 , Hidekatsu Kuroda  24 , Tomomitsu Matono  25 , Tomoko Aoki  26 , Yuki Kanayama  1 , Kazunari Tanaka  13 , Fujimasa Tada  4 , Kazuhiro Nouso  7 , Asahiro Morishita  8 , Akemi Tsutsui  10 , Takuya Nagano  10 , Norio Itokawa  9 , Tomomi Okubo  9 , Taeang Arai  9 , Michitaka Imai  14 , Shinichiro Nakamura  5 , Hirayuki Enomoto  12 , Masaki Kaibori  20 , Yoichi Hiasa  6 , Masatoshi Kudo  26 , Takashi Kumada  27 ; Real‐life Practice Experts for, HCC (RELPEC) Study Group, and, HCC 48 Group (Hepatocellular Carcinoma Experts from 48 Clinics in Japan)
Affiliations
Comparative Study

Predictive factors and survival outcome of conversion therapy for unresectable hepatocellular carcinoma patients receiving atezolizumab and bevacizumab: Comparative analysis of conversion, partial response and complete response patients

Takeshi Hatanaka et al. Aliment Pharmacol Ther. 2024 Nov.

Abstract

Aim: This study aims to investigate the predictive factors for conversion therapy in patients with unresectable hepatocellular carcinoma (uHCC) and to evaluate the prognosis of conversion cases by comparing them with partial response (PR) and complete response (CR) cases.

Methods: In this retrospective multicentre study, we included a total of 946 uHCC patients treated with atezolizumab and bevacizumab (Atez/Bev) from September 2020 to September 2023.

Results: Out of the patients, 43 (4.5%) received conversion therapy following Atez/Bev treatment. The overall response rate was 65.1% and 23.7% in the conversion and non-conversion group, respectively, with a statistical significance (p < 0.001). Multivariate analyses identified that BCLC stage B or an earlier stage (p = 0.045), absence of macrovascular invasion and extrahepatic spread (p = 0.045), and a low value of neutrophil to lymphocyte ratio (p = 0.04) were significantly favourable predictive factors associated with conversion therapy. The conversion group showed significantly better survival compared to the non-conversion group (p < 0.001). In the landmark analysis at 6, 12 and 18 months, the conversion group exhibited better survival compared to PR patients in the non-conversion group (p = 0.04, 0.01 and 0.03, respectively) and there were no significant differences in the overall survival (OS) between the conversion group and patients who achieved a CR (p = 0.7, 1.0 and 0.3, respectively).

Conclusions: Patients with low tumour burden and low value of NLR were more likely to undergo conversion therapy. The OS of patients undergoing conversion therapy showed better survival compared to those achieving PR and was comparable to those with CR patients. Conversion therapy could be considered if feasible.

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References

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