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. 2026 Mar 17:101827.
doi: 10.1016/j.jhepr.2026.101827. Online ahead of print.

Atezolizumab-Bevacizumab in Very Elderly With Hepatocellular Carcinoma: Age Alone Is Not a Limiting Factor Except in ALBI Grade 3

Chloé Métivier  1 , Claudia Campani  2 , Manon Allaire  3 , Rémy Morello  4 , Sarah Mouri  3 , Eleonore Spitzer  3 , Mohamed Bouattour  5 , Clémence Hollande  5 , Sabrina Sidali  6 , Jean Charles Nault  2 , Nathalie Ganne-Carrié  7 , Pierre Nahon  7 , Giuliana Amaddeo  8 , Hélène Regnault  8 , Paul Vigneron  8 , Jean Marie Péron  9 , Leila Sadek  9 , Cecile Cussac  9 , Marie Lequoy  10 , Violaine Ozenne  11 , Marie-Pierre Galais  11 , Claire Pérignon  12 , Louise Lebedel  12 , Marion Habireche  12 , Apolline Commin  12 , Thông Dao  12 , Charlotte Costentin  13 , Aurore Baron  14 , Isabelle Ollivier Hourmand  15
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Free article

Atezolizumab-Bevacizumab in Very Elderly With Hepatocellular Carcinoma: Age Alone Is Not a Limiting Factor Except in ALBI Grade 3

Chloé Métivier et al. JHEP Rep. .
Free article

Abstract

Background and aims: Evidence on atezolizumab plus bevacizumab (AtezoBev) in very elderly with hepatocellular carcinoma (HCC) remains rare in European ancestry population. We compared outcomes in patients aged ≥75 years with younger patients.

Methods: This multicenter retrospective study included patients treated with first-line AtezoBev for advanced HCC. Patients aged ≥75 years were matched 1:1 with those <75 years using propensity scores. Overall survival (OS), progression-free survival (PFS), tumor response, and adverse events (AEs) were analyzed.

Results: Among 814 patients, 566 (69.5%) were <75 (median age 64, 84% male) and 248 (30.5%) ≥75 (median age 78, 86% male). After matching, 484 were analyzed. After a median follow-up of 28.0 months, OS and PFS were similar in ≥75 and <75 (15.4 vs 16.07 months; p=0.936), (7.2 vs 6.5 months; p=0.706) respectively. Age ≥ 75 years was not associated with PFS nor OS. In patients aged ≥ 75 years, modified Albumin-Bilirubin grade 3 (mALBI) was the only factor associated with disease progression (HR 4.37, 95% CI 2.04,9.37; p<0.001) and mortality (HR 5.62, 95% CI 2.47,12.8; p<0.001). In mALBI 3 median OS and PFS were 5.43 (2.93-) and 2.3 months (1.63-) respectively. Immune-related AEs (IRAEs) were less frequent in ≥ 75 including (22.1% vs 36.9%; p<0.001) or excluding dysthyroidism (15.9% vs 25.9%; p=0.01). In univariate analysis, OS and PFS were longer in patients ≥ 75 years who developed hypertension (p=0.04 and p=0.09), proteinuria (p<0.0001 and p=0.015) and IRAEs (p=0.02 and p=0.007). Hypertension during treatment was associated with proteinuria (odds ratio=13.1; 95% CI 4.1-42.4), without difference at baseline (p=0.35).

Conclusion: Atezolizumab-Bevacizumab is effective and safe in patients ≥ 75 years but mALBI 3 warrants particular caution.

Clinical number: NCT06416683.

Keywords: atezolizumab-bevacizumab; hepatocellular carcinoma; very elderly; ≥75 years.

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