Efficacy and safety of atezolizumab and bevacizumab in real-world treatment of advanced hepatocellular carcinoma: experience from a cancer center in Brazil

Keywords

liver - hepatocellular - carcinoma - atezolizumab - bevacizumab

Background/aim: The combination of atezolizumab-bevacizumab changed the prognosis of unresectable hepatocellular carcinoma (HCC) since 2020. Present study aimed evaluate the outcomes of HCC patients who received this combination in a Cancer Center in Brazil and which factors were associated with prognosis. Patients and methods: This was a retrospective study of first-line patients treated with atezolizumab-bevacizumab from 2020 to 204. Patients’ data were collected retrospectively from patients’ files. Survival curves were calculated with the Kaplan–Meier method and compared by means of the log-rank test stratified by clinical pathological features.

Results: Forty patients were included; Most patients had had BCLC C disease (80.0%). Most common hepatitis etiology was NASH (42.5%); viral etiology composed 20%. Twenty-one (52.5%) patients had esophageal varices before treatment. Thirty-two patients had Child-Pugh A cirrhosis (80.0%), 22 (55.5%) had ALBI score 1 and macrovascular invasion was present in 23 patients (57.5%). Response evaluation was performed in 34 patients; response rate was 35.3%; disease control rate was 85.3%. In progressive disease, 14 patients had second-line treatment; in 11 of them Lenvatinib was performed. Five patients had variceal bleeding and five had immune-related adverse events (irAE). Median PFS and OS were 7.4 (95% CI: 2.4-12.4) and 19.3 (95% CI: 9.2-29.4) months, respectively. Factors associated with worst prognosis were Child B, macrovascular invasion and esophageal varices. There was no association between cirrhosis etiology with survival. We found no association between response rate stratified by hepatitis etiology or Child classification.

Conclusion: Our data had had comparable prognosis of the pivotal IMBRAVE trial, despite including patients with Child B liver function. Clinical factors like Child B, macrovascular invasion and esophageal varices were associated with worst survival.

Corresponding author: Daniela De Almeida Carvalho (e-mail: [e-mail]).