Manzar Gohar Shahwar, De Brian Sandeep, Abana Chike Osita, Lee Sunyoung S, Javle Milind, Kaseb Ahmed O, Vauthey Jean-Nicolas, Tran Cao Hop Sanderson, Koong Albert C, Smith Grace Li, Taniguchi Cullen M, Holliday Emma Brey, Das Prajnan, Koay Eugene Jon, Ludmir Ethan Bernard
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
Cancers (Basel). 2022 Apr 9;14(8):1901. doi: 10.3390/cancers14081901.
Atezolizumab plus bevacizumab has become frontline therapy for unresectable HCC. The compatibility of atezolizumab/bevacizumab with liver-directed RT has not been reported. Methods: HCC patients treated with liver-directed RT and atezolizumab/bevacizumab between 1/2020−11/2021 were included. Toxicity and outcomes were retrospectively recorded. For ALCs, we matched the analysis to a previously cohort of RT-treated HCC patients who did not receive atezolizumab/bevacizumab. Survival and time-to-liver-failure were analyzed using Kaplan−Meier. Results: Of 21 patients, with a median follow-up of 9.5 months, the median OS was 16.1 months. Post-RT, all patients had reduced tumors or treatment response. There were no ≥Grade 3 RT-related toxicities. Autoimmune complications occurred in two patients (9.5%), and GI bleeding in three patients (14.3%). Liver function remained stable post-RT. There was a marked decrease in ALCs immediately post-RT (post-RT/pre-RT ratio 47.3%, p < 0.0001), restored by 1 month to pre-treatment baseline (1-month post-RT/pre-RT ratio 95.1%, n.s.). Compared to HCC patients treated with RT alone, post-RT ALC recovery was faster with atezolizumab/bevacizumab (p = 0.009). Conclusion: In this first reported experience of RT with modern systemic therapy for HCC, combination therapy is safe and well-tolerated. As a favorable prognosticator, there appears to be faster recovery of ALC among patients who received RT with atezolizumab/bevacizumab.
阿替利珠单抗联合贝伐单抗已成为不可切除肝细胞癌的一线治疗方案。阿替利珠单抗/贝伐单抗与肝靶向放疗的兼容性尚未见报道。方法：纳入2020年1月至2021年11月期间接受肝靶向放疗及阿替利珠单抗/贝伐单抗治疗的肝细胞癌患者。回顾性记录毒性反应和治疗结果。对于接受肝动脉化疗栓塞术（ALCs）的患者，我们将分析结果与之前一组未接受阿替利珠单抗/贝伐单抗治疗的接受放疗的肝细胞癌患者进行匹配。采用Kaplan-Meier法分析生存率和肝衰竭时间。结果：21例患者的中位随访时间为9.5个月，中位总生存期为16.1个月。放疗后，所有患者肿瘤均缩小或有治疗反应。无≥3级放疗相关毒性反应。2例患者（9.5%）出现自身免疫并发症，3例患者（14.3%）出现消化道出血。放疗后肝功能保持稳定。放疗后即刻肝动脉化疗栓塞术（ALCs）明显下降（放疗后/放疗前比值为47.3%，p<0.0001），1个月后恢复至治疗前基线水平（放疗后1个月/放疗前比值为95.1%，无统计学差异）。与单纯接受放疗的肝细胞癌患者相比，接受阿替利珠单抗/贝伐单抗放疗的患者放疗后肝动脉化疗栓塞术（ALC）恢复更快（p=0.009）。结论：在首次报道的肝细胞癌现代全身治疗联合放疗的经验中，联合治疗安全且耐受性良好。作为一个有利的预后指标，接受阿替利珠单抗/贝伐单抗放疗的患者肝动脉化疗栓塞术（ALC）恢复似乎更快。
