Impact of first-line systemic therapy with atezolizumab plus bevacizumab in patients with hepatocellular carcinoma.

Abstract

The study goal was to compare the outcomes of patients with unresectable hepatocellular carcinoma (HCC) who received atezolizumab plus bevacizumab (Atezo/Bev) as either first- or later-line systemic therapy. A total of 430 patients with HCC treated with Atezo/Bev at 22 institutions in Japan were included. Patients treated with Atezo/Bev as first-line therapy for HCC were defined as the first-line group (n=268) while those treated with Atezo/Bev as second- or later-line therapy were defined as the later-line group (n=162). The median progression-free survival times in the first- and later-line groups were 7.7months (95% confidence interval [CI], 6.7-9.2) and 6.2months (95% CI, 5.0-7.7) (P=0.021). Regarding treatment-related adverse events, hypertension of any grade was more common in the first-line group than in the later-line group (P=0.025). Analysis adjusted by inverse probability weighting, including patient and HCC characteristics, showed that the later-line group (hazard ratio, 1.304; 95% CI, 1.006-1.690; P=0.045) was significantly associated with progression-free survival. In patients with Barcelona Clinic Liver Cancer stage B, the median progression-free survival times in the first- and later-line groups were 10.5months (95% CI, 6.8-13.8) and 6.8months (95% CI, 5.0-9.4) (P=0.021). Among patients with a history of lenvatinib therapy, the median progression-free survival times in the first- and later-line groups were 7.7months (95% CI, 6.3-9.2) and 6.2months (95% CI, 5.0-7.7) (P=0.022). The use of Atezo/Bev as first-line systemic therapy in patients with HCC is expected to prolong survival.