Safety and Efficacy of Atezolizumab and Bevacizumab Combination as a First Line Treatment of Advanced Hepatocellular Carcinoma

Abstract

Hepatocellular carcinoma (HCC) is one of the most common leading causes of cancer death worldwide. As most patients are diagnosed with advanced disease, systemic therapy remains the backbone of treatment. In recent years, we have witnessed the transformation of advanced HCC treatment landscapes from single-agent targeted therapies to immunotherapy combinations, with atezolizumab plus bevacizumab becoming the new first-line standard of care with an increase in overall survival, progression-free survival, and objective response rate compared to sorafenib, and a positive impact on quality of life. Although the efficacy and safety of this combination have been confirmed regardless of ethnicity, age, and etiology, only a subgroup of patients seems to benefit the most from this treatment. Currently, predictive serum and tissue biomarkers to select patients who are most likely to respond to atezolizumab plus bevacizumab are lacking. Moreover, the optimal subsequent therapy for patients who progress on first-line atezolizumab plus bevacizumab remains unknown, clinical trials are ongoing, and real-world data are needed to determine the most effective treatment sequence. Importantly, careful evaluation of bleeding risk and preservation of adequate liver function are fundamental to improve patients’ prognosis, especially when subsequent treatments are administered.

Portal Venous and Hepatic Arterial Coefficients Predict Post-Hepatectomy Overall and Recurrence-Free Survival in Patients with Hepatocellular Carcinoma: A Retrospective Study

“…The following data at admission were retrospectively analyzed in the present study: sex; age, which was stratified into ≤ 65 or > 65 years old; 15 , 16 albumin and total bilirubin (ALBI) score, which is a well-established model for assessing liver function in patients with HCC and is calculated using the following formula: ; 17 hepatitis B and/or C viral infection by detecting serum surface antigen of hepatitis B virus and detecting serum antibodies against hepatitis C virus; 18 liver cirrhosis, diagnosed by ultrasonography, triphasic liver CT, and/or MRI as described; 19 a serum α fetoprotein level of < 400 ng/mL or ≥ 400 ng/mL; 20 and Barcelona Clinic Liver Cancer (BCLC) stage. 14 …”

Efficacy and safety of apatinib plus immune checkpoint inhibitors and transarterial chemoembolization for the treatment of advanced hepatocellular carcinoma

“…For patients with advanced HCC, the recommended standard treatment according to the guidelines in China is transarterial chemoembolization (TACE) with or without systematic therapy, which includes tyrosine kinase inhibitors (TKIs) (such as sorafenib, lenvatinib, and donafenil), chemotherapy based on oxaliplatin, and atezolizumab plus bevacizumab (Chen et al 2020a , b ; Xie et al 2023a , b ). However, the outcomes of these patients are still not satisfactory (Chen et al 2022a , b ; Wang et al 2022 ; Zanuso et al 2023 ).…”