Therapeutic Modifications without Discontinuation of Atezolizumab Plus Bevacizumab Therapy Are Associated with Favorable Overall Survival and Time to Progression in Patients with Unresectable Hepatocellular Carcinoma

Author:

Tokunaga Takayuki1ORCID,Tateyama Masakuni1,Kondo Yasuteru2ORCID,Miuma Satoshi3ORCID,Miyase Shiho4,Tanaka Kentaro1,Narahara Satoshi1,Inada Hiroki1,Kurano Sotaro1,Yoshimaru Yoko1,Nagaoka Katsuya1ORCID,Watanabe Takehisa1ORCID,Setoyama Hiroko1,Fukubayashi Kotaro5,Tanaka Motohiko6,Tanaka Yasuhito1ORCID

Affiliation:

1. Department of Gastroenterology and Hepatology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto City 860-8556, Kumamoto, Japan

2. Sendai Kousei Hospital, 4-15 Sakamoto, Aoba-ku, Sendai City 980-0873, Miyagi, Japan

3. Department of Gastroenterology and Hepatology, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki City 852-8501, Nagasaki, Japan

4. Kumamoto Shinto General Hospital, 3-2-65 Ooe, Chuo-ku, Kumamoto City 862-8655, Kumamoto, Japan

5. Kumamoto Kenhoku Hospital, 550 Tamana, Tamana City 860-0005, Kumamoto, Japan

6. Public Health and Welfare Bureau, City of Kumamoto, 1-1 Tetori-honcho, Chuo-ku, Kumamoto City 860-8601, Kumamoto, Japan

Abstract

We retrospectively evaluated the impact of therapeutic modifications of atezolizumab (Atezo) plus bevacizumab (Bev) therapy (Atezo/Bev), including the interruption or discontinuation of both Atezo and Bev, and the reduction or discontinuation of Bev, on the outcome of patients with unresectable hepatocellular carcinoma (uHCC) (median observation period: 9.40 months). One hundred uHCC from five hospitals were included. Therapeutic modifications without discontinuation of both Atezo and Bev (n = 46) were associated with favorable overall survival (median not reached; hazard ratio (HR): 0.23) and time to progression (median: 10.00 months; HR: 0.23) with no therapeutic modification defined as the reference. In contrast, the discontinuation of both Atezo and Bev without other therapeutic modifications (n = 20) was associated with unfavorable overall survival (median: 9.63 months; HR: 2.72) and time to progression (median: 2.53 months; HR: 2.78). Patients with modified albumin–bilirubin grade 2b liver function (n = 43) or immune-related adverse events (irAEs) (n = 31) discontinued both Atezo and Bev without other therapeutic modifications more frequently (30.2% and 35.5%, respectively) than those with modified albumin–bilirubin grade 1 (10.2%) and without irAEs (13.0%). Patients with objective response (n = 48) experienced irAEs more frequently (n = 21) than those without (n = 10) (p = 0.027). Avoiding the discontinuation of both Atezo and Bev without other therapeutic modifications may be the optimal management of uHCC.

Funder

the Kumamoto University Hospital Young Researcher Activation Project

Publisher

MDPI AG

Subject

Cancer Research,Oncology

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