ADVERTISEMENT
Efficacy and safety of atezolizumab plus bevacizumab in unresectable or advanced hepatocellular carcinoma: Real life data from 5 Swiss centers
Background
The landscape of systemic therapies (ST) for advanced hepatocellular carcinoma (HCC) pts has evolved in recent years. So far, the IMbrave 150 study (NCT03434379; Finn RS NEJM 2020), with the combination of atezolizumab (atezo) + bevacizumab (bev), obtained the best results regarding overall survival (OS) and progression free survival (PFS) in systemic treatment (ST) naïve pts. Still, data from real life scenario on the safety and efficacy of this therapy is lacking. The aim of the study is to report results of atezo + bev outside RCT focusing on safety and efficacy measures.
Methods
This is a retrospective observational study of pts diagnosed with advanced HCC with atezo + bev in real life clinical practice from January 2020 - November 2021.
Results
83 pts were included. Median follow up 11 months(IQR 5-16). Male sex81%. Median age 68. Risk factors for HCC; 29% alcohol, 26% viral, 14% nash, 11% alcohol+nash, 14% alcohol+viral, 5% other. Cirrhotic yes 82%. BCLC B25%, C 75%. Prior ST 14%. Priot LRT 70%. Vascular invasion 40%. Number of lesions 1 (14%), 2 (10%), 3 or more (55%), diffuse (14%). AFP≥400 (7%). ChildPugh class A5 40%A6 45% B7 4%B8 8%. EHS present in 42%. At the moment of analysis, 18 pts had ongoing ST with atezo + bev and 41 pts were alive. Pts received a median of 6 cycles (IQR 4-10). 49 pts (59%) presented some treatment related adverse event (AE). Grade 3-4 AE in 24 pts (29%). Grade 5 AE were seen in 6 pts (7%). Serious AE in 19 pts (23%). The most frequent being variceal bleeding, AKI-HRS, IO related colitis and liver failure. AE leading to drug withdrawal occurred in 20 pts (24%). 29 pts (35%) received ST after atezo + bev. OS at 6 and 12 months was 75.2% (95%CI 64-83) and 61.6% (95%CI 49.4-71-7), respectively. PFS at 6 and 12 months was 42.7% (CI 95% 31.8-53) and 24.8% (95%CI 15-36), respectively. During follow up 1 pt achieved successful DS and got OLT with no recurrence after 9 months of follow up. So far, 4 pts have achieved CR.
Conclusions
In this preliminary report of real life atezo + bev efficacy measures were slightly beneath results of RCT setting. These differences could be explained by inclusion of pts with previous ST, Child B patients and more flexible comorbidities criteria. Regarding safety the total AE were less than reported in RCT. Atezo + bev did not disappoint in the forecast made by IMbrave 150 study, neither in the expected AE nor in the prognosis. In individual cases, therapy was successful in bringing pts to a curative approach.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosures
All authors have declared no conflicts of interest.
