Himmelsbach Vera, Pinter Matthias, Scheiner Bernhard, Venerito Marino, Sinner Friedrich, Zimpel Carolin, Marquardt Jens U, Trojan Jörg, Waidmann Oliver, Finkelmeier Fabian
Department of Gastroenterology, Hepatology and Endocrinology, University Hospital Frankfurt, 60590 Frankfurt, Germany.
Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, 1090 Vienna, Austria.
Cancers (Basel). 2022 Mar 28;14(7):1722. doi: 10.3390/cancers14071722.
The combination of atezolizumab and bevacizumab (A + B) is the new standard of care for the systemic first-line treatment of hepatocellular carcinoma (HCC). However, up to now there are only few data on the safety and efficacy of A + B in real life. We included patients with advanced HCC treated with A + B as first-line therapy at four cancer centers in Germany and Austria between December 2018 and August 2021. Demographics, overall survival (OS), and adverse events were assessed until 15 September 2021. We included 66 patients. Most patients had compensated cirrhosis (n = 34; 52%), while Child-Pugh class B cirrhosis was observed in 23 patients (35%), and class C cirrhosis in 5 patients (8%). The best responses included a complete response (CR) in 7 patients (11%), a partial response (PR) in 12 patients (18%), stable disease (SD) in 22 patients (33%), and progressive disease in 11 patients (17%) The median progression-free (PFS) survival was 6.5 months, while the median overall survival (OS) was not reached in this cohort (6-month OS: 69%, 12-month OS: 60%, 18-month OS: 58%). Patients with viral hepatitis seemed to have a better prognosis than patients with HCC of non-viral etiology. The real-world PFS and OS were comparable to those of the pivotal IMBRAVE trial, despite including patients with worse liver function in this study. We conclude that A + B is also highly effective in a real-life setting, with manageable toxicity, especially in patients with compensated liver disease. In patients with compromised liver function (Child B and C), the treatment showed low efficacy and, therefore, it should be well considered before administration to these patients.
阿替利珠单抗与贝伐单抗联合用药（A+B）是肝细胞癌（HCC）全身一线治疗的新标准。然而，到目前为止，关于A+B在实际应用中的安全性和有效性的数据还很少。我们纳入了2018年12月至2021年8月期间在德国和奥地利的四个癌症中心接受A+B一线治疗的晚期HCC患者。评估了患者的人口统计学特征、总生存期（OS）和不良事件，直至2021年9月15日。我们纳入了66例患者。大多数患者有代偿性肝硬化（n=34；52%），23例患者（35%）观察到Child-Pugh B级肝硬化，5例患者（8%）为C级肝硬化。最佳疗效包括7例患者（11%）完全缓解（CR），12例患者（18%）部分缓解（PR），22例患者（33%）疾病稳定（SD），11例患者（17%）疾病进展。中位无进展生存期（PFS）为6.5个月，而该队列的中位总生存期（OS）未达到（6个月OS：69%，12个月OS：60%，18个月OS：58%）。病毒性肝炎患者的预后似乎比非病毒性病因的HCC患者更好。尽管本研究纳入了肝功能较差的患者，但实际应用中的PFS和OS与关键的IMBRAVE试验相当。我们得出结论，A+B在实际应用中也非常有效，毒性可控，尤其是在代偿性肝病患者中。在肝功能受损（Child B和C级）的患者中，该治疗显示出低疗效，因此，在对这些患者给药前应充分考虑。
