Real-World Outcomes of Atezolizumab with Bevacizumab Treatment in Hepatocellular Carcinoma Patients: Effectiveness, Esophagogastroduodenoscopy Utilization and Bleeding Complications
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Study Population
2.3. Data Collection
2.4. Statistical Analysis
3. Results
3.1. Patient Population
3.2. Effectiveness of Atezolizumab and Bevacizumab
3.3. EGD Utilization and Esophagogastric Varices
3.4. Bleeding Events during A+B Treatment
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Correction Statement
References
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Characteristic | Total (n = 112) |
---|---|
Median Age (IQR), years | 66 (24–85) |
Sex | |
Male | 97 (87%) |
Female | 15 (13%) |
Ethnicity | |
East-Asian | 27 (24%) |
Other | 85 (76%) |
Province | |
Alberta | 60 (54%) |
Ontario | 48 (43%) |
Manitoba | 3 (3%) |
Unknown | 1 |
ECOG performance score | |
0 | 53 (47%) |
1 | 54 (48%) |
2 | 4 (4%) |
3 | 1 (1%) |
Child-Pugh score | |
A | 99 (91%) |
B | 10 (9%) |
Unknown | 3 |
Albumin-bilirubin (ALBI) grade | |
1 | 50 (45%) |
2 | 60 (54%) |
3 | 1 (1%) |
Unknown | 1 |
Barcelona Clinic Liver Cancer (BCLC) stage | |
A | 7 (6%) |
B | 26 (23%) |
C | 79 (71%) |
Liver disease etiology | |
Hepatitis C | 37 (35%) |
Hepatitis B | 28 (26%) |
Alcohol use | 25 (23%) |
NASH | 17 (16%) |
Other | 5 |
Cirrhosis | |
Yes | 75 (67%) |
No | 37 (33%) |
Liver resection | 29 (28%) |
Prior locoregional therapy | |
Yes | 57(72%) |
No | 22 (28%) |
Unknown | 33 |
Type of locoregional therapy | |
Radiofrequency Ablation (RFA) | 33 (29%) |
Stereotactic Body Radiation Therapy (SBRT) | 17 (15%) |
y-90 Radioembolization | 6 (5.4%) |
Transarterial embolization (TAE) | 4 (3.6%) |
Transarterial chemoembolization (TACE) | 29 (26%) |
1 | 11 (38%) |
2 | 14 (48%) |
3 | 4 (14%) |
Tumor histology | |
HCC | 73 (65%) |
Mixed HCC-CCA | 3 (3%) |
No biopsy/Unknown | 36 (32%) |
Size of largest lesion, cm | |
Median (IQR) | 3.8 (0.0–18.0) |
Unknown | 16 |
Tumor distribution | |
Unilobar | 55 (50%) |
Bilobar | 55 (50%) |
Unknown | 2 |
Macrovascular invasion | |
Yes | 41 (37%) |
No | 70 (63%) |
Unknown | 1 |
Presence of lymph node or extrahepatic metastasis | |
Lymph node involvement | 31 (28%) |
Extrahepatic metastasis | 41 (37%) |
Completed EGD within 6 months | |
Yes | 79 (71%) |
No | 33 (29%) |
Reasons for no EGD | |
No radiological evidence of cirrhosis or varices | 4 (12%) |
Limited EGD availability | 2 (6%) |
Patient refusal (with EGD within 7 months) | 1(3%) |
Unknown | 26 (79%) |
Varices | |
Detected on EGD | 32 (41%) |
Required intervention before A+B | 15 (19%) |
No previous EGD/Unknown | 34 |
Baseline AFP level, µg/L | |
Median (IQR) | 47.0 (1.0–86,709) |
Unknown | 2 |
Baseline platelet count, ×109/L | |
Median (IQR) | 177.0 (49.0–574.0) |
Unknown | 1 |
Reasons for A+B discontinuation | |
Disease progression | 30 (37%) |
Patient choice | 21 (26%) |
Toxicities | 15 (18.5%) |
Death | 15 (18.5%) |
Characteristic | Total (n = 112) |
---|---|
First-line regimen (n = 112) | |
A+B | 101(90%) |
Lenvatinib | 6 (5%) |
Sorafenib | 4 (4%) |
Chemotherapy | 1 (1%) |
Second-line regimen (n = 39) | |
Lenvatinib | 25 (64%) |
A+B | 10 (26%) |
Sorafenib | 2 (5%) |
Chemotherapy | 2 (5%) |
Third-line regimen (n = 7) | |
Regorafenib | 2 (29%) |
Lenvatinib | 2 (29%) |
A+B | 1 (14%) |
Cabozantinib | 1 (14%) |
Sorafenib | 1 (14%) |
A+B prior to TKIs | 101 (90%) |
TKIs prior to A+B | 11 (10%) |
Characteristics | This Study (n = 112) | IMbrave150 [11] (n = 336) | ||
---|---|---|---|---|
Median follow-up period (95% CI), months | 10.4 (0.4–47.9) | 17.6 (0.1–28.6) | ||
Median treatment duration | 6.4 (0.2–29.8) | 8.4 (3.5–18.3) | ||
Median OS (95% CI) months | 20.3 (16.5-NR) | 19.2 (17.0–23.7) | ||
18-months OS | 55% | 52% | ||
Median OS (patients with bleeding vs. without bleeding) | 20.3 (13.0-NR) vs. 19.7 (16.5-NR); p = 0.86 | |||
Median PFS * (95% CI), months | 9.6 (6.1–11.9) | 6.9 (5.7–8.6) | ||
Median PFS (patients with bleeding vs. without bleeding) | 10.3 (5.0–27.1) vs. 9.6 (7.4–13.6) p = 0.95 | |||
ORR * | Overall (n = 112) | First-line (n = 101) | Subsequent-line (n = 11) | Overall (n = 336) |
Complete response no. (%) | 1(1%) | 0 (0%) | 1 (11.1%) | 25 (8%) |
Partial response no. (%) | 36 (35.0%) | 33 (35.1%) | 3 (33.3%) | 72 (22%) |
Stable disease no. (%) | 42 (40.8%) | 39 (41.5%) | 3 (33.3%) | 144 (44%) |
Progressive disease no. (%) | 24 (23.3%) | 22 (23.4%) | 2 (22.2%) | 63(19%) |
Could not be evaluated/Missing no. | 9 | 7 | 2 | 22 (7%) |
EGD within 6 Months | ||||
---|---|---|---|---|
Characteristic | Total (n = 112) | Yes (n = 79) | No (n = 33) | p-Value |
Cirrhosis | 75 | 51(68%) | 24(32%) | 0.45 |
Platelet count, ×109/L | ||||
Median (IQR) | 177 (49–574) | 162 (65–574) | 189 (49–486) | 0.17 |
Albumin, g/L | ||||
Median (IQR) | 39.0 (24–421) | 39 (26–421) | 39 (24–48) | 0.70 |
INR | ||||
Median (IQR) | 1.1 (0.9–1.8) | 1.1(0.9–1.4) | 1.1 (0.9–1.8) | 0.86 |
Total Bilirubin, µmol/L | ||||
Median (IQR) | 15 (3–72) | 15 (3–72) | 16 (3–57) | 0.56 |
Size of largest tumor, cm | ||||
Mean ± SD | 96 | 6.0 ± 4.3 | 5.7 ± 4.8 | 0.56 |
Unknown | 16 | |||
Macrovascular invasion | 41 | 12 (15%) | 28 (85%) | 0.88 |
Unknown | 1 | |||
Bleeding events | 17 | 14 (18%) | 3 (9%) | 0.24 |
GI-specific bleeding | 6 | 5 (6%) | 1 (3%) |
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Share and Cite
Lee, C.L.; Freeman, M.; Burak, K.W.; Moffat, G.T.; O’Donnell, C.D.J.; Ding, P.Q.; Lyubetska, H.; Meyers, B.M.; Gordon, V.; Kosyachkova, E.; et al. Real-World Outcomes of Atezolizumab with Bevacizumab Treatment in Hepatocellular Carcinoma Patients: Effectiveness, Esophagogastroduodenoscopy Utilization and Bleeding Complications. Cancers 2024, 16, 2878. https://doi.org/10.3390/cancers16162878
Lee CL, Freeman M, Burak KW, Moffat GT, O’Donnell CDJ, Ding PQ, Lyubetska H, Meyers BM, Gordon V, Kosyachkova E, et al. Real-World Outcomes of Atezolizumab with Bevacizumab Treatment in Hepatocellular Carcinoma Patients: Effectiveness, Esophagogastroduodenoscopy Utilization and Bleeding Complications. Cancers. 2024; 16(16):2878. https://doi.org/10.3390/cancers16162878
Chicago/Turabian StyleLee, Cha Len, Mark Freeman, Kelly W. Burak, Gordon T. Moffat, Conor D. J. O’Donnell, Philip Q. Ding, Hanna Lyubetska, Brandon M. Meyers, Vallerie Gordon, Ekaterina Kosyachkova, and et al. 2024. "Real-World Outcomes of Atezolizumab with Bevacizumab Treatment in Hepatocellular Carcinoma Patients: Effectiveness, Esophagogastroduodenoscopy Utilization and Bleeding Complications" Cancers 16, no. 16: 2878. https://doi.org/10.3390/cancers16162878
APA StyleLee, C. L., Freeman, M., Burak, K. W., Moffat, G. T., O’Donnell, C. D. J., Ding, P. Q., Lyubetska, H., Meyers, B. M., Gordon, V., Kosyachkova, E., Bucur, R., Cheung, W. Y., Knox, J. J., & Tam, V. C. (2024). Real-World Outcomes of Atezolizumab with Bevacizumab Treatment in Hepatocellular Carcinoma Patients: Effectiveness, Esophagogastroduodenoscopy Utilization and Bleeding Complications. Cancers, 16(16), 2878. https://doi.org/10.3390/cancers16162878