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de Castro T, Jochheim LS, Bathon M, Welland S, Scheiner B, Shmanko K, Roessler D, Khaled NB, Jeschke M, Ludwig JM, Marquardt JU, Weinmann A, Pinter M, Lange CM, Vogel A, Saborowski A. Atezolizumab and bevacizumab in patients with advanced hepatocellular carcinoma with impaired liver function and prior systemic therapy: a real-world experience. Ther Adv Med Oncol 2022; 14:17588359221080298. [PMID: 35251317 PMCID: PMC8891886 DOI: 10.1177/17588359221080298] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 01/28/2022] [Indexed: 12/13/2022] Open
Abstract
Objective: Evaluation of the efficacy and safety of atezolizumab/bevacizumab in a
real-world HCC cohort, including patients with impaired liver function and
prior systemic therapy. Methods: Retrospective analysis of 147 HCC patients treated with
atezolizumab/bevacizumab at six sites in Germany and Austria. Results: The overall response rate and disease control rate were 20.4% and 51.7%,
respectively. Seventy-three patients (49.7%) met at least one major
exclusion criterion of the IMbrave150 trial (IMbrave-OUT), whereas 74
patients (50.3%) were eligible (IMbrave-IN). Median overall survival (mOS)
as well as median progression-free survival (mPFS) was significantly longer
in IMbrave-IN versus IMbrave-OUT patients [mOS: 15.0 months
(95% confidence interval (CI): 10.7–19.3] versus 6.0 months
(95% CI: 3.2–8.9; p < 0.001) and mPFS: 8.7 months (95%
CI: 5.9–11.5) versus 3.7 months (95% CI: 2.7–4.7;
p < 0.001)]. Prior systemic treatment did not
significantly affect mOS [hazard ratio (HR): 1.32 (95% CI: 0.78–2.23;
p = 0.305)]. mOS according to ALBI grades 1/2/3 were
15.0 months (95% CI: not estimable), 8.6 months (95% CI: 5.4–11.7), and
3.2 months (95% CI: 0.3–6.1), respectively. ALBI grade and ECOG score were
identified as independent prognostic factors [ALBI grade 2
versus 1; HR: 2.40 (95% CI: 1.34 – 4.30;
p = 0.003), ALBI grade 3 versus 1; HR:
7.28 (95% CI: 3.30–16.08; p < 0.001), and ECOG ⩾2
versus 0; HR: 2.09 (95% CI: 1.03 – 4.23;
p = 0.042)], respectively. Sixty-seven patients (45.6%)
experienced an adverse event classified as CTCAE grade ⩾3. Patients in the
IMbrave-OUT group were at increased risk of hepatic decompensation with
encephalopathy (13.7% versus 1.4%,
p = 0.004) and/or ascites (39.7% versus
9.5%; p < 0.001). Conclusion: In this real-world cohort, efficacy was comparable to the results of the
IMbrave150 study and not affected by prior systemic treatment. ALBI grade
and ECOG score were independently associated with survival. IMbrave-OUT
patients were more likely to experience hepatic decompensation.
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Affiliation(s)
- Tiago de Castro
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Leonie S. Jochheim
- Department of Gastroenterology and Hepatology, Essen University Hospital, Essen, Germany
| | - Melanie Bathon
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Sabrina Welland
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Bernhard Scheiner
- Division of Gastroenterology & Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Kateryna Shmanko
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Daniel Roessler
- Department of Medicine II, University Hospital of the Ludwig-Maximilians-University Munich, Munich, Germany
| | - Najib Ben Khaled
- Department of Medicine II, University Hospital of the Ludwig-Maximilians-University Munich, Munich, Germany
| | - Matthias Jeschke
- Department of Gastroenterology and Hepatology, Essen University Hospital, Essen, Germany
| | - Johannes M. Ludwig
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, Faculty of Medicine, Essen University Hospital, Essen, Germany
| | - Jens U. Marquardt
- Department of Medicine I, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Arndt Weinmann
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Matthias Pinter
- Division of Gastroenterology & Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Christian M. Lange
- Department of Gastroenterology and Hepatology, Essen University Hospital, Essen, Germany
| | - Arndt Vogel
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Anna Saborowski
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
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