Prognosis and treatment pattern of advanced hepatocellular carcinoma after failure of first-line atezolizumab and bevacizumab treatment

Chen, Ching-Tso; Feng, Yin‐Hsun; Yen, Chia‐Jui; Chen, San‐Chi; Lin, Yun-Tzu; Lu, Lichun; Hsu, Chih‐Hung; Cheng, Ann‐Lii; Shao, Yu‐Yun

doi:10.1007/s12072-022-10392-x

Cited by 32 publications

(27 citation statements)

References 27 publications

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“…There are currently limited data on the efficacy of TKIs following immunotherapy-based combinations. These data suggest similar efficacy and safety as when used in first-line [ 42 , 43 ]. Despite this paucity of data, most updates of guidelines do recommend the use of TKIs after progression on first-line atezolizumab-bevacizumab.…”

Section: Current and Future Second-line Options In The Area Of First-...mentioning

confidence: 57%

New Challenges Facing Systemic Therapies of Advanced HCC in the Era of Different First-Line Immunotherapy-Based Combinations

Edeline

Meyer

Blanc

et al. 2022

Cancers

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The standard of care of first-line systemic therapy for advanced hepatocellular carcinoma (HCC) is currently changing with the results of the IMbrave150 trial which are demonstrating superiority of the atezolizumab-bevacizumab combination over sorafenib, modifying this line of treatment for the first time in over 10 years. Recently, other immunotherapy-based combinations (durvalumab-tremelimumab, lenvatinib-pembrolizumab, cabozantinib-atezolizumab, and camrelizumab-rivoceranib) reported results in phase III studies, and might challenge this new standard of care. This revolution will lead to a considerable change in practice, and highlight challenges for future drug development. In this review, we will, firstly, describe results of the different combinations, and discuss the difficulties in selecting the first-line treatment. We will then present the different recommendations about second-line treatment following the first-line immunotherapy-based combination, discussing the rationale for the differences in existing recommendations. We will finally discuss the challenges for future drug development in advanced HCC.

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Section: Current and Future Second-line Options In The Area Of First-...mentioning

confidence: 57%

New Challenges Facing Systemic Therapies of Advanced HCC in the Era of Different First-Line Immunotherapy-Based Combinations

Edeline

Meyer

Blanc

et al. 2022

Cancers

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“…Four types of proven rst-line treatment options were administrated to 14 patients in the study. Previous studies have often focused on speci c subgroups with a particular treatment regimen, such as atezolizumab plus bevacizumab [29] . In terms of methodology, this study provides a general understanding of second-line therapy, whereas Shao et al provided a more targeted understanding.…”

Section: Discussionmentioning

confidence: 99%

Transarterial chemoembolization for advanced hepatocellular carcinoma after failure of first-line systemic treatment: a single-center case series

Leng,

Diao,

You

et al. 2023

Preprint

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Purpose: To demonstrate the potential benefits of additional transarterial chemoembolization (TACE) for advanced hepatocellular carcinoma (HCC) after the failure of first-line systemic treatment (ST). Methods: This retrospective single-center study was conducted between January 2020 and December 2022 on patients with advanced HCC who failed to respond to initial first-line ST. Patients who had previously undergone TACE were excluded. Eligible patients underwent on-demand TACE in addition to ST and were followed until death or until March 2023. The duration of response was recorded. Overall survival (OS) was calculated from the date of failure of first-line ST to the date of death or last follow-up. The primary outcomes were OS and safety, and the secondary outcomes were time to progression (TTP) and objective response rate (ORR). Results: In total, 18 patients were included; 8 patients had failed to respond to lenvatinib or sorafenib monotherapy, and 10 had failed to respond to a combination therapy. The most common progression pattern was the development of new intrahepatic lesions. Salvage treatment consisted of 16 triple therapies and 2 dual therapies, including TACE. The median duration of follow-up was 9.5 months. The median OS from the start of second-line treatment was 24 months. The median TTP was 3.5 months. The ORR was 55.6%, and disease control was achieved in 94.4% of patients. Treatment-related adverse events were common but acceptable. Conclusion: Patients with advanced HCC who face significant treatment challenges could potentially benefit from the addition of TACE to second-line ST.

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“…Although the evidence for treatment post‐Atezo/Beva failure is still unclear, the most common second‐line therapies after Atezo/Beva treatment are LEN and SORA in real‐world practice 25–27 . A previous study reported that the median PFS was 6.1 and 2.5 months after progression to Atezo/Beva therapy in patients undergoing LEN and SORA treatment, respectively 27 .…”

Section: Discussionmentioning

confidence: 99%

“…24 Vascular endothelial growth factor-2 is known to be a receptor for Although the evidence for treatment post-Atezo/Beva failure is still unclear, the most common second-line therapies after Atezo/ Beva treatment are LEN and SORA in real-world practice. [25][26][27] A previous study reported that the median PFS was 6.1 and 2.5 months after progression to Atezo/Beva therapy in patients undergoing LEN and SORA treatment, respectively. 27 Lenvatinib has been shown to be a good sequential treatment option in patients with better hepatic reserve function 28 and it especially has a high response following Atezo/Beva treatment.…”

Section: Assessment Of Aes In Ram Treatmentmentioning

confidence: 99%

Significance of ramucirumab following atezolizumab plus bevacizumab therapy for hepatocellular carcinoma using real‐world data

Shimose

Sugimoto

Hiraoka

et al. 2022

Hepatology Research

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Aim Few studies have reported the efficacy and safety of ramucirumab (RAM) after atezolizumab plus bevacizumab (Atezo/Beva) treatment and the overall associated outcomes. Thus, we aimed to evaluate the therapeutic effects and safety of RAM post‐treatment with Atezo/Beva. Methods This retrospective study enrolled 46 patients with unresectable hepatocellular carcinoma who were treated with RAM. The patients were classified into the RAM administered following Atezo/Beva failure (n = 12) or RAM administered following other drug failure (n = 34) groups. Progression‐free survival (PFS), overall survival (OS), and adverse event (AE) rates were assessed. Results There were significant differences in the objective response rates and disease control rates between the RAM administered following Atezo/Beva and RAM administered following others groups (objective response rate 33.3%. vs. 0.0%, p = 0.001; disease control rate 83.3% vs. 32.3, p = 0.001). Although there was no significant difference in the OS rates, the median PFS rates in the RAM administered following Atezo/Beva group was significantly higher than in the RAM administered following others group (PFS 3.9 months. vs. 1.9 months, p = 0.047). The AE rates were comparable between the two groups; ascites was the most common AE (45.6%). Using decision tree analysis, the presence of splenomegaly and body mass index (BMI) < 19.8 were the first and second splitting variables for RAM‐related ascites, respectively. Conclusions The therapeutic effect of RAM increased in patients with Atezo/Beva failure. Patients with splenomegaly and low BMI should be monitored for ascites during RAM treatment.

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Prognosis and treatment pattern of advanced hepatocellular carcinoma after failure of first-line atezolizumab and bevacizumab treatment

Cited by 32 publications

References 27 publications

New Challenges Facing Systemic Therapies of Advanced HCC in the Era of Different First-Line Immunotherapy-Based Combinations

New Challenges Facing Systemic Therapies of Advanced HCC in the Era of Different First-Line Immunotherapy-Based Combinations

Transarterial chemoembolization for advanced hepatocellular carcinoma after failure of first-line systemic treatment: a single-center case series

Significance of ramucirumab following atezolizumab plus bevacizumab therapy for hepatocellular carcinoma using real‐world data

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