Efficacy and Effect on Liver Functional Reserve of Atezolizumab and Bevacizumab for Unresectable Hepatocellular Carcinoma in Patients Who Do Not Meet Eligibility Criteria of IMbrave150

Abstract

The IMbrave150 trial demonstrated the high efficacy and safety of atezolizumab and bevacizumab for unresectable hepatocellular carcinoma (HCC). In this multicenter study, the efficacy of this combination and its effect on liver functional reserve were evaluated in patients not meeting the eligibility criteria of IMbrave150. Of 115 patients with unresectable HCC treated with atezolizumab and bevacizumab between October 2020 and January 2022, 72 did not meet the eligibility criteria of IMbrave150, most frequently due to a history of systemic therapy (60/72), platelet counts < 75 × 109/L (7/72), Child-Pugh B (9/72), and 2+ proteinuria (8/72). Atezolizumab and bevacizumab therapy was equally effective for patients who did or did not meet the eligibility criteria (PFS, 6.5 vs. 6.9 months, p = 0.765), consistent with subgroup analyses of histories of systemic therapy, platelet counts, Child-Pugh, and proteinuria. Baseline ALBI scores were worse in patients who did not meet the criteria than in those who did and significantly worsened after treatment initiation in patients not meeting the criteria (baseline vs. 12 weeks; 2.35 ± 0.43 vs. −2.18 ± 0.54; p = 0.007). Accordingly, atezolizumab plus bevacizumab was effective for patients not meeting the eligibility criteria of IMbrave150, although careful monitoring for changes in liver functional reserve is needed.

Efficacy and safety of atezolizumab plus bevacizumab treatment for advanced hepatocellular carcinoma in the real world: a systematic review and single-arm meta-analysis

“…Moreover, all four studies reported the short-term OR evaluated with mRECIST, and the pooled OR rate was 25% (95% CI, 20-30%, I 2 = 37.64%, p = 0.19, Fig. 2D), while three [24,29,30] of the four studies reported the short-term CR and PR evaluated with mRECIST, and the pooled CR and PR rates were 3% (95% CI, 0-5%, I 2 = 0.00%, p = 0.74, Fig. 3D) and 24% (95% CI, 18-30%, I 2 = 32.04%, p = 0.23, Fig.…”

“…2C). Three [24,29,30] of the four studies reported the short-term CR and PR evaluated with RECIST, and the pooled CR and PR rates were 0% (95% CI, 0-1%, I 2 = 0.00%, p = 0.97, Fig. 3C) and 15% (95% CI, 7-23%, I 2 = 64.79%, p = 0.06, Fig.…”

“…5A). Ten studies [17,21,25,26,30,31,32,35,40,42] reported the complete mPFS data, and the pooled mPFS was 6.66 months (95% CI, 6.07-7.26, I2 = 0.0%, p = 0.973, Fig. 5B).…”

“…Four studies [24,29,30,37] reported the short-term (six weeks) performance of atezolizumab combined with bevacizumab in advanced HCC. All four studies reported the short-term OR evaluated with RECIST, and the pooled OR rate was 13% (95% CI, 9-17%, I 2 = 47.23%, p = 0.13, Fig.…”

“…4A), respectively. In addition, eight [17,22,23,28,30,37,40,41] of the 19 studies reported the long-term OR, CR, and PR evaluated with modi ed RECIST (mRECIST), and the pooled OR rate was 33% (95% CI, 26-40%, I 2 = 71.31%, p = 0.00, Fig. 2B), while the pooled CR and PR rates were 4% (95% CI, 1-9%, I 2 = 80.54%, p = 0.00, Fig.…”