Risk of Variceal Bleeding in Patients With Advanced Hepatocellular Carcinoma Receiving Atezolizumab/Bevacizumab

Ha, Yeonjung; Kim, Jee Hyun; Cheon, Jaekyung; Jeon, Gyeong Sik; Kim, Chan; Chon, Hong Jae

doi:10.1016/j.cgh.2022.07.035

Cited by 12 publications

(17 citation statements)

References 6 publications

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“…Thereafter, 21 articles were excluded and 15 studies were finally included for meta-analysis (1 clinical trial and 14 observational studies), [13,[23][24][25][26][27][28][29][30][31][32][33][34][35][36] 4 of these being abstracts. [25][26][27][28] Between reviewer agreement for the inclusion process was 0.75 (95% CI, 0.70-0.80), as assessed by the kappa coefficient. There was disagreement with respect to 4 studies and it was resolved by a third reviewer (M.R.…”

Section: Resultsmentioning

confidence: 99%

“…After initial screening, 186 articles not relevant for the study were excluded and 36 potential study reports were assessed for eligibility at the full-text level. Thereafter, 21 articles were excluded and 15 studies were finally included for meta-analysis (1 clinical trial and 14 observational studies), [13,[23][24][25][26][27][28][29][30][31][32][33][34][35][36] 4 of these being abstracts. [25][26][27][28] Between reviewer agreement for the inclusion process was 0.75 (95% CI, 0.70-0.80), as assessed by the kappa coefficient.…”

Section: Resultsmentioning

confidence: 99%

“…[20][21][22] Regardless the lack of any evidence, it has been widely hypothesized that immunotherapy could potentially have a less pronounced impact on liver function and could be safer for HCC patients with liver dysfunction, resulting in improved survival. However, until now only 1 single-arm clinical trial with nivolumab in first-line or after sorafenib [12] has evaluated this population and some immunotherapy-based regimes [23][24][25][26][27][28][29][30][31][32][33][34][35][36] have assessed this special population and in real-life studies reported heterogeneous results.…”

Section: Introductionmentioning

confidence: 99%

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Outcome of patients with HCC and liver dysfunction under immunotherapy: a systematic review and meta-analysis

et al. 2023

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Background and Aims: Immunotherapy-based regimes have changed the management of HCC. However, evidence of efficacy in patients with impaired liver function is unknown. This systematic review and metaanalysis assesses survival of HCC patients and liver dysfunction treated with immunotherapy-based regimens. Methods: Systematic review and meta-analysis of original articles or abstracts reporting survival of HCC patients treated with immunotherapy according to liver function between 2017 and 2022. Overal survival (OS) according to restricted mean survival time (RMST) and median OS, and hazard ratio (HR) of Child-Pugh B or B/C versus Child-Pugh A were assessed while considering the line of treatment. Results: Of the 2218 articles considered, 15 articles recruiting 2311 patients were included. Of these, 639 (27.7%) were Child-Pugh B and 34 (1.5%) C.RMST was 8.36 (95% CI, 6.15-10.57; I 2 = 93%) months, estimated from 8 studies. The HR was reported in 8 studies for survival between Child-Pugh B

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Outcome of patients with HCC and liver dysfunction under immunotherapy: a systematic review and meta-analysis

et al. 2023

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“…As gastrointestinal bleeding and perforation have been reported to occur on using bevacizumab, 2 patients in our study developed grade 3 or higher gastrointestinal bleeding, a rate which was higher than those previously reported on using only atezo/bev ( 7 , 33 ). This may be due to the fact that most of the included patients with VP4 PVTT ( 34 ). However, no patients died from treatment-related side effects which was unexpected given the relatively advanced HCC stages of our patients who had also received IMRT ( 35 , 36 ).…”

Section: Discussionmentioning

confidence: 99%

Intensity-modulated radiotherapy combined with systemic atezolizumab and bevacizumab in treatment of hepatocellular carcinoma with extrahepatic portal vein tumor thrombus: A preliminary multicenter single-arm prospective study

Wang

Xiang

et al. 2023

Front. Immunol.

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Background and aimsThe efficacy and safety of systemic atezolizumab and bevacizumab (atezo/bev) in treatment of patients with unresectable hepatocellular carcinoma (HCC) have been demonstrated. However, the efficacy of this treatment in patients with HCC and extrahepatic portal vein tumor thrombus (ePVTT) is not satisfactory. This study aimed to study the efficacy and safety of combining intensity-modulated radiotherapy (IMRT) with systemic atezo/bev in treatment of these patients.MethodsThis multicenter prospective study included patients with ePVTT treated with IMRT combined with atezo/bev from March to September 2021 in three centers in China. The outcomes of this study included objective response rate (ORR), overall survival (OS), progression-free survival (PFS), time to progression (TTP), and association between response and tumor mutational burden (TMB). Treatment-related adverse events (TRAEs) were analyzed to assess safety.ResultsOf 30 patients in this study, the median follow-up was 7.4 months. Based on the Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1, the ORR was 76.6%, the median OS for the entire cohort was 9.8 months, the median PFS was 8.0 months, and the median TTP was not reached. This study failed to establish a significant correlation between TMB with any of the following outcomes, including ORR, OS, PFS or TTP. The most common TRAEs at all levels were neutropenia (46.7%), and the most common grade 3/4 TRAE was hypertension (16.7%). There was no treatment-related deaths.ConclusionsIMRT combined with atezo/bev showed encouraging treatment efficacy with an acceptable safety profile, making this treatment to be a promising option for HCC patients with ePVTT. Further studies are required to support the findings of this preliminary study.Clinical trial registrationhttp://www.chictr.org.cn, Identifier ChiCTR2200061793.

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“…Patients require a detailed physical examination depending on the treatment strategy and need to be informed of precursory symptoms of adverse events for better self-monitoring during stages of treatment. For instance, patients with advanced HCC should undergo esophagogastroduodenoscopy prior to atezolizumab-bevacizumab therapy because the combination treatment is accompanied by a higher risk of bleeding (205,206). In addition, an evaluation for the presence of varices is recommended within 6 months of initiation of atezolizumab-bevacizumab (110).…”

Section: Treatment-related Toxicitymentioning

confidence: 99%

An overview: Management of patients with advanced hepatocellular carcinoma

Wang

Sun

et al. 2022

BST

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Risk of Variceal Bleeding in Patients With Advanced Hepatocellular Carcinoma Receiving Atezolizumab/Bevacizumab

Cited by 12 publications

References 6 publications

Outcome of patients with HCC and liver dysfunction under immunotherapy: a systematic review and meta-analysis

Outcome of patients with HCC and liver dysfunction under immunotherapy: a systematic review and meta-analysis

Intensity-modulated radiotherapy combined with systemic atezolizumab and bevacizumab in treatment of hepatocellular carcinoma with extrahepatic portal vein tumor thrombus: A preliminary multicenter single-arm prospective study

An overview: Management of patients with advanced hepatocellular carcinoma

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