Real-World Data for Atezolizumab Plus Bevacizumab in Unresectable Hepatocellular Carcinoma: How Does Adherence to the IMbrave150 Trial Inclusion Criteria Impact Prognosis?

Rimini, Margherita; Persano, Mara; Tada, Toshifumi; Suda, Goki; Shimose, Shigeo; Kudo, Masatoshi; Cheon, Jaekyung; Finkelmeier, Fabian; Lim, Ho Yeong; Presa, José; Masi, Gianluca; Yoo, Changhoon; Piscaglia, Fabio; Kumada, Takashi; Sakamoto, Naoya; Iwamoto, Hideki; Aoki, Tomoko; Chon, Hong Jae; Himmelsbach, Vera; Pressiani, Tiziana; Montes, Margarida; Vivaldi, Caterina; Soldà, Caterina; Hiraoka, Atsushi; Sho, Takuya; Nishizaki, Takashi; Nishida, Naoshi; Steup, Christoph; Hirooka, Masashi; Kariyama, Kazuya; Tani, Joji; Atsukawa, Masanori; Takaguchi, Koichi; Itobayashi, Ei; Fukunishi, Shinya; Tsuji, Kiichiro; Ishikawa, Toru; Tajiri, Kazuto; Ochi, Hironori; Yasuda, Satoshi; Toyoda, Hidenori; Ogawa, Chikara; Nishimura, Takashi; Hatanaka, Takeshi; Kakizaki, Satoru; Shimada, Noritomo; Kawata, Kazuhito; Tada, Fujimasa; Ohama, Hideko; Nouso, Kazuhiro; Morishita, Asahiro; Tsutsui, Akemi; Nagano, Takuya; Itokawa, Norio; Okubo, Tomomi; Arai, Taeang; Imai, Michitaka; Kosaka, Hisashi; Naganuma, Akira; Nakamura, Shinichiro; Kaibori, Masaki; Iijima, Hiroko; Hiasa, Yoichi; Burgio, Valentina; Rimassa, Lorenza; Scartozzi, Mario; Cascinu, Stefano; Casadei‐Gardini, Andrea

doi:10.1007/s11523-023-00953-x

Cited by 15 publications

(8 citation statements)

References 28 publications

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“…A recent real-world analysis based on this study but with no specific inclusion and exclusion criteria investigated the safety and efficacy of the combination and found that adherence to IMbrave 150 trial inclusion criteria favorably impacted the prognosis of patients but also showed that patients with grade 1 ALBI (another prognostic score) who does not meet classic CP-A due to subjective variability also benefit from the treatment. 22 Another real-world analysis by Cheon et al looked at the efficacy and safety of atezo-bev in 36 patients with CP-B scores and showed modest clinical activity. However, it had an increased frequency of serious adverse events (44.4 vs. 15.8%, p < 0.001).…”

Section: Fda-approved First-line Treatment Atezolizumab and Bevacizum...mentioning

confidence: 99%

Hepatocellular Carcinoma: Advances in Systemic Therapy

Selene,

Ozen,

Patel

2024

Semin intervent Radiol

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Hepatocellular carcinoma (HCC) is a prevalent primary liver cancer, representing over 90% of cases globally and ranking as the third leading cause of cancer-related death. This article reviews the evolving landscape of systemic therapies for advanced HCC, emphasizing recent advancements and their impact on patient outcomes. The advent of molecular targeted therapies has transformed HCC management, with sorafenib being the first FDA-approved molecular targeted therapy, setting a standard for a decade. However, recent breakthroughs involve the combination of atezolizumab and bevacizumab, demonstrating superior outcomes over sorafenib, leading to FDA approval in 2020. Another notable combination is tremelimumab and durvalumab, showing efficacy in a multinational phase III trial. Beyond these combinations, this article explores the role of other first-line treatments and subsequent therapies after progression. The evolving landscape of systemic therapies for HCC reflects a paradigm shift, with immunotherapy combinations emerging as key players alongside targeted therapies. This article highlights the complexity of treatment decisions, considering individual patient characteristics and disease etiology, and underscores the ongoing quest to optimize both systemic and local–regional therapies for improved long-term outcomes in HCC patients.

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Section: Fda-approved First-line Treatment Atezolizumab and Bevacizum...mentioning

confidence: 99%

Hepatocellular Carcinoma: Advances in Systemic Therapy

Selene,

Ozen,

Patel

2024

Semin intervent Radiol

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“…Unpredictable severe side effects development Despite the adequate safety profile of combinations of immunotherapy in the CT 15,17 and real-world data in Asia, 27 Japan, 28 Korea, 26 and Europe 29,30 the impact of developing adverse events (AE) and outcome is still under evolution.…”

Section: Variable Patient Outcomementioning

confidence: 99%

“…While having more choices is beneficial for patients, it is also associated with shorter treatment durations and potentially reduced effectiveness of each treatment. 29,92 The BCLC approach proposes utilizing the "BCLC upon progression" classification, 91,93 which incorporates tumor stage, liver function, ECOG-PS at the time of initiating the first line option and also at the time of progression plus characterize the progression pattern to adopt a multi-parameter approach. However, the decision to discontinue treatment must also consider other factors, such as the profile of AE during on-going treatment and the alternative options available if the patient discontinues the ongoing treatment.…”

Section: Misunderstanding Of the Clinical Benefits And Competition Fr...mentioning

confidence: 99%

“…Nevertheless, despite the concepts of “clinical benefit” or “treatment beyond progression” being tentatively incorporated, the cessation of treatment upon progression remains a concern in the era of numerous options. While having more choices is beneficial for patients, it is also associated with shorter treatment durations and potentially reduced effectiveness of each treatment 29,92 …”

Section: Swot Analysis Of Systemic Treatment In Hcc Fieldmentioning

confidence: 99%

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Systemic therapies in hepatocellular carcinoma: A revolution?

Fortuny,

Sanduzzi‐Zamparelli,

Reig

2024

UEG Journal

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The evolution in systemic therapies in hepatocellular carcinoma (HCC) signifies a strategy of high‐cost, high‐gain innovation that originated with sorafenib, despite its limited impact on tumor response. This strategic approach paved the way for the emergence of a second wave of the short‐lived competitive advantage, exemplified by the incorporation of atezolizumab plus bevacizumab and tremelimumab plus durvalumab. In the context of safety concerns within the liver cancer domain, the IMBRAVE150 and HIMALAYA trials boldly incorporated bevacizumab and tremelimumab, respectively, demonstrating the continuation of the high‐risk, high‐reward innovation paradigm. This review delves into the strengths, weaknesses, opportunities, and threats analysis of systemic therapies in the field of HCC.

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“…The definition of prognostic and predictive factors of response to treatments remains an unmet need for this setting of patients, despite several investigations in real-world setting were carried out. [10][11][12][13][14][15][16][17][18] The role of nutritional status in affecting response to treatment represents a classes in a large sample of patients affected by HCC and receiving atezolizumab plus bevacizumab or lenvatinib as first-line treatment.…”

Section: Introductionmentioning

confidence: 99%

Impact of body mass index on the prognosis of unresectable HCC patients receiving first‐line Lenvatinib or atezolizumab plus bevacizumab

Rimini,

Stefanini,

Tada

et al. 2024

Liver International

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IntroductionOverweight is a negative prognostic factor in the general population in the long term. However, the role of body mass index (BMI) in the short‐mid term in advanced tumours is unclear. The present analysis investigates the role of BMI weight classes in a large sample of patients affected by HCC and receiving atezolizumab plus bevacizumab or lenvatinib as first‐line treatment.Methods and MaterialThe cohort included consecutive patients affected by BCLC‐c and BCLC‐B HCC patients from a multicenter international study group who received atezolizumab plus bevacizumab or lenvatinib as first‐line therapy. Population was stratified according to the BMI in under‐, over‐ and normal‐weight according to the conventional thresholds.The primary objective of the study was to evaluate the prognostic and predictive impact of BMI in patients affected by advanced or intermediate HCC. Survival curves were estimated using the product‐limit method of Kaplan–Meier. The role of stratification factors was analysed with log‐rank tests.Results1292 consecutive patients with HCC were analysed. 466 (36%) patients were treated with lenvatinib and 826 (64%) patients were treated with atezolizumab plus bevacizumab. In the atezolizumab plus bevacizumab arm, 510 (62%) patients were normal‐weight, 52 (6%) underweight and 264 (32%) overweight. At the univariate analysis for OS, underweight patients had significantly shorter OS compared to normal‐weight patients, whereas no differences were found between normal‐weight versus overweight. Multivariate analysis confirmed that underweight patients had significantly shorter OS compared to normal‐weight patients (HR: 1.7; 95% CI: 1.0–2.8; p = .0323). In the lenvatinib arm, 26 patients (5.6%) were categorized as underweight, 256 (54.9%) as normal‐weight, and 184 (39.5%) as overweight. At the univariate analysis for OS, no significant differences were found between normal‐weight versus underweight and between normal‐weight versus overweight, which was confirmed at multivariate analysis.ConclusionOur analysis highlighted a prognostic role of BMI in a cohort of patients with advanced HCC who received atezolizumab plus bevacizumab, while no prognostic role for low BMI was apparent in patients who received lenvatinib.

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Real-World Data for Atezolizumab Plus Bevacizumab in Unresectable Hepatocellular Carcinoma: How Does Adherence to the IMbrave150 Trial Inclusion Criteria Impact Prognosis?

Cited by 15 publications

References 28 publications

Hepatocellular Carcinoma: Advances in Systemic Therapy

Hepatocellular Carcinoma: Advances in Systemic Therapy

Systemic therapies in hepatocellular carcinoma: A revolution?

Impact of body mass index on the prognosis of unresectable HCC patients receiving first‐line Lenvatinib or atezolizumab plus bevacizumab

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