Author:
Vithayathil Mathew,D’Alessio Antonio,Fulgenzi Claudia Angela Maria,Nishida Naoshi,Schönlein Martin,von Felden Johann,Schulze Kornelius,Wege Henning,Saeed Anwaar,Wietharn Brooke,Hildebrand Hannah,Wu Linda,Ang Celina,Marron Thomas U.,Weinmann Arndt,Galle Peter R.,Bettinger Dominik,Bengsch Bertram,Vogel Arndt,Balcar Lorenz,Scheiner Bernhard,Lee Pei-Chang,Huang Yi-Hsiang,Amara Suneetha,Muzaffar Mahvish,Naqash Abdul Rafeh,Cammarota Antonella,Zanuso Valentina,Pressiani Tiziana,Pinter Matthias,Cortellini Alessio,Kudo Masatoshi,Rimassa Lorenza,Pinato David J.,Sharma Rohini
Abstract
Abstract
Background
Atezolizumab plus bevacizumab (Atezo/Bev) is first line-treatment for unresectable hepatocellular carcinoma (HCC). Body mass index (BMI) has demonstrated predictive value for response to immunotherapy in non-HCC cancer types. Our study investigated the effect of BMI on safety and efficacy of real-life use of Atezo/Bev for unresectable HCC.
Methods
191 consecutive patients from seven centres receiving Atezo/Bev were included in the retrospective study. Overall survival (OS), progression-free survival (PFS), overall response rate (ORR) and disease control rate (DCR) defined by RECIST v1.1 were measured in overweight (BMI ≥ 25) and non-overweight (BMI < 25) patients. Treatment-related adverse events (trAEs) were evaluated.
Results
Patients in the overweight cohort (n = 94) had higher rates of non-alcoholic fatty liver disease (NAFLD) and lower rates of Hepatitis B compared to non-overweight cohort (n = 97). Baseline Child–Pugh class and Barcelona Clinic Liver Cancer stage were similar between cohorts, with lower rates of extrahepatic spread in the overweight group. Overweight patients had similar OS compared to non-overweight (median OS 15.1 vs. 14.9 months; p = 0.99). BMI did not influence median PFS (7.1 vs. 6.1 months; p = 0.42), ORR (27.2% vs. 22.0%; p = 0.44) and DCR (74.1% vs. 71.9%; p = 0.46). There were higher rates of atezolizumab-related fatigue (22.3% vs. 10.3%; p = 0.02) and bevacizumab-related thrombosis (8.5% vs. 2.1%; p = 0.045) in the overweight patients, but overall trAEs and treatment discontinuation were comparable between cohorts.
Conclusion
Atezo/Bev has comparable efficacy in overweight HCC patients, with an increase in treatment-related fatigue and thrombosis. Combination therapy is safe and efficacious to use in overweight patients, including those with underlying NAFLD.
Funder
National Institute of Helath Research
European Association for the Study of the Liver
Wellcome Trust
NIHR Imperial Biomedical Research Centre
Publisher
Springer Science and Business Media LLC
Cited by
7 articles.
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