Liver and Bile
Hepatology. 2022;76(4):1000–12
Preliminary evidence of safety and tolerability of atezolizumab plus bevacizumab in patients with hepatocellular carcinoma and Child-Pugh A and B cirrhosis: A real-world study
Background and aims: Atezolizumab plus bevacizumab is the standard of care for first-line treatment of unresectable hepatocellular carcinoma (HCC). No evidence exists as to its use in routine clinical practice in patients with impaired liver function.
Approach and results: In 216 patients with HCC who were consecutively treated with atezolizumab plus bevacizumab across 11 tertiary centers, the authors retrospectively evaluated treatment-related adverse events (trAEs) graded (G) according to Common Terminology Criteria for Adverse Events v5.0, including in the analysis all patients treated according to label (n = 202, 94%). They also assessed overall survival (OS), progression-free survival (PFS), overall response (ORR), and disease control rates (DCR) defined by Response Evaluation Criteria in Solid Tumors v1.1. Disease was mostly secondary to viral hepatitis, namely hepatitis C (n = 72, 36%) and hepatitis B infection (n = 35, 17%). Liver function was graded as Child-Pugh (CP)-A in 154 patients (76%) and CP-B in 48 (24%). Any grade trAEs were reported by 143 patients (71%), of which 53 (26%) were G3 and 3 (2%) G4. Compared with CP-A, patients with CP-B showed comparable rates of trAEs. Presence and grade of varices at pretreatment esophagogastroduodenoscopy did not correlate with bleeding events. After a median follow-up of 9.0 months (95% confidence interval [CI]: 7.8–10.1), median OS was 14.9 months (95% CI: 13.6–16.3), whereas median PFS was 6.8 months (95% CI: 5.2–8.5). ORR and DCR were respectively 25% and 73%, with no difference across CP classes.
Conclusions: This study confirms reproducible safety and efficacy of atezolizumab plus bevacizumab in routine practice. Patients with Child-Pugh-B reported similar tolerability compared with Child-Pugh-A, warranting prospective evaluation of atezolizumab plus bevacizumab in this treatment-deprived population.