Pretreatment Neutrophil-to-Lymphocyte Ratio as a Predictive Marker of Response to Atezolizumab Plus Bevacizumab for Hepatocellular Carcinoma

Abstract

Background: Combination therapy with anti-programmed death-ligand 1 monoclonal antibody atezolizumab plus anti-vascular endothelial growth factor agent bevacizumab (Atezo/Bev) was approved in 2020 as a first-line treatment for unresectable hepatocellular carcinoma (HCC). Atezo/Bev therapy is relatively well tolerated; however, factors that can predict its response have not yet been reported. Thus, we aimed to investigate whether the pretreatment neutrophil-to-lymphocyte ratio (NLR) could predict the therapeutic response in patients with HCC treated with Atezo/Bev therapy. Methods: We analyzed the course of 40 patients with HCC who received Atezo/Bev therapy at our hospital and attempted to identify pretreatment factors that could predict response by comparing those who achieved disease control with those who did not. Results: The pretreatment NLR value in patients who achieved disease control was significantly lower than that in patients with disease progression (2.47 vs. 4.48, p = 0.013). Using the optimal NLR cut-off value for predicting response (3.21) determined by receiver operating characteristic curve analysis, patients with NLR ≤ 3.21 had significantly better progression-free survival than those with NLR > 3.21 (p < 0.0001), although there were no significant differences in liver function or tumor-related background factors between the two groups. Conclusions: The pretreatment NLR value may be a useful predictor of response to Atezo/Bev therapy for HCC.

Evaluating the Role of Hepatobiliary Phase of Gadoxetic Acid-Enhanced Magnetic Resonance Imaging in Predicting Treatment Impact of Lenvatinib and Atezolizumab plus Bevacizumab on Unresectable Hepatocellular Carcinoma

“…The third main finding of our study was that assessment by the EOB-MRI hepatobiliary phase affected PFS in the atezolizumab plus bevacizumab group (Figures 1 and 2). We also examined liver function and the neutrophil-to-lymphocyte ratio (NLR) that have been reported to be associated with PFS for atezolizumab plus bevacizumab therapy, but found no statistical differences [20,21]. One of the reasons for predicting therapeutic effects is that the heterogeneous and hyperintense types were present in a certain number of patients with HCC carrying β-catenin mutation.…”

Pretreatment Positron Emission Tomography with ¹⁸F-Fluorodeoxyglucose May Be a Useful New Predictor of Early Progressive Disease following Atezolizumab plus Bevacizumab in Patients with Unresectable Hepatocellular Carcinoma

“…This difference may have been due to the small number of cases in the current study. In addition, it should be noted that previously reported NLR cut-off values for predicting patient outcomes differ between studies [15, 43-45], and NLRs change due to various patient conditions (e.g., infections and certain medications, particularly steroid-based immunosuppressive regimens). Therefore, more robust NLR cut-off values are desirable for use in daily clinical practice.…”

“…As in the previous reports [41,42], readministration of lenvatinib after diagnosed disease progression during immunotherapies has the potential of disease control effect in some patients. Recently, other researchers reported the utility of NLRs for predicting patient outcomes following Atezo/Bev treatment of HCC [15,[43][44][45]. Furthermore, Maesaka et al [15] reported an NLR cut-off value of ≥3 as a useful predictor for HPD.…”

Pretreatment Modified Albumin–Bilirubin Grade Is an Important Predictive Factor Associated with the Therapeutic Response and the Continuation of Atezolizumab plus Bevacizumab Combination Therapy for Patients with Unresectable Hepatocellular Carcinoma

“…Chuma et al reported that ATZ + BV treatment might offer significant benefits in patients who meet the IMbrave150 trial or have a low NLR [ 31 ]. Eso et al reported that pretreatment NLR might be a useful predictive factor associated with the therapeutic response [ 32 ]. NLR is a marker of systemic inflammatory response and reflects the balance between the neutrophils and lymphocytes [ 33 ].…”