Abstract
Hepatocellular carcinoma (HCC) is a challenging to treat malignancy with few available systemic therapies. Angiogenesis has been implicated in the pathogenesis of HCC and prior studies have suggested a role for anti‐VEGF therapy. Prior to FDA approval of second‐line therapy for advanced HCC, from 2008 until 2017, we initiated bevacizumab monotherapy (5‐10 mg/kg every 2‐3 weeks) in 12 patients with intolerance of or progression during sorafenib therapy. Bevacizumab therapy was well tolerated with only 1/12 patients experiencing a grade 3‐4 treatment‐related adverse event (transient ischemic attack) and only 2/12 patients discontinued the therapy due to adverse events. Median overall survival was 20.2 months (IQR, 7.0‐43.5), with a median time to radiologic progression of 10.4 months (IQR, 2.8‐16.1) and a disease control rate of 54%. Taken together, our experience provides rationale for further prospective investigation of bevacizumab for the treatment of advanced HCC.
Highlights
There are an estimated 42 220 new cases of hepatocellular carcinoma (HCC) annually in the United States with an associated 5 year overall survival of less than 20%.1 Partly due to the lack of new effective therapies, HCC mortality rates have increased nationally over the last several decades.[2]
IQR, interquartile range. aOverall survival was defined as time from start of bevacizumab to death. bTime to radiological progression was defined as the time from start of bevacizumab to progression on imaging as defined by mRECIST. cLevel of response was measured according to mRECIST. dThe disease control rate was the percentage of patients who had a best‐response rating of complete or partial response or stable disease at any time point while on treatment with bevacizumab
In this single‐institution retrospective case series, we describe our experience treating advanced HCC with bevacizumab
Summary
There are an estimated 42 220 new cases of hepatocellular carcinoma (HCC) annually in the United States with an associated 5 year overall survival of less than 20%.1 Partly due to the lack of new effective therapies, HCC mortality rates have increased nationally over the last several decades.[2]. Due to the lack of new effective therapies, HCC mortality rates have increased nationally over the last several decades.[2] A paucity of systemic therapy options for advanced disease has been especially problematic. In 2008, Llovet et al, in a phase III randomized controlled trial (RCT), demonstrated the efficacy of sorafenib for the treatment of advanced HCC (HR 0.69; 95% CI, 0.55‐0.87; P < 0.001). Prior to 2017, sorafenib was the only US Food and Drug Administration (FDA) approved agent for the treatment of advanced HCC. Given the lack of available systemic therapies prior to 2017 and based upon phase II results and medication availability, we utilized bevacizumab off‐label as a second‐line agent for the treatment of patients with advanced HCC who progressed on or were intolerant of. We report our experience treating advanced HCC with bevacizumab
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