Department of Regenerative Medicine, Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama, Japan.
Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
Cancer Med. 2023 Sep;12(17):17559-17568. doi: 10.1002/cam4.6369. Epub 2023 Aug 3.
The IMbrave 150 trial revealed the usefulness of atezolizumab plus bevacizumab therapy in patients with unresectable hepatocellular carcinoma (HCC), making it now considered the first-line systemic chemotherapy agent for HCC. The present study investigated factors associated with early tumor progression of atezolizumab plus bevacizumab in patients with advanced HCC in real-world clinical practice.
A total of 184 HCC patients who received atezolizumab plus bevacizumab therapy were studied. We investigated the frequency of early progressive disease (e-PD; PD within 9 weeks) and analyzed the risk factors for e-PD.
There were 47 patients (25.5%) diagnosed as e-PD. Patients with e-PD had a worse performance status (PS) and albumin-bilirubin (ALBI) and Child-Pugh (C-P) scores and a significantly higher rate of a systemic therapy than those with non-e-PD. A multivariate analysis showed that PS ≥1 (odds ratio [OR] = 4.5, 95% confidence interval [CI] = 1.9-10, p < 0.001), ALBI score ≥-2.30 (OR = 2.1, 95% CI = 1.0-4.5, p = 0.044) and the history of a systemic therapy (OR = 3.0, 95% CI = 1.4-6.4, p = 0.0038) were significant and independent determinants of e-PD. When examining the liver function trends in e-PD patients, the ALBI scores at 3 and 6 weeks after starting therapy were significantly higher than before the treatment (p < 0.001).
The liver function and systemic therapy are useful predictors of e-PD in HCC patients treated with atezolizumab plus bevacizumab in real-world clinical practice.
IMbrave 150 试验表明阿替利珠单抗联合贝伐珠单抗治疗在不可切除肝细胞癌（HCC）患者中的有效性，使其成为 HCC 的一线系统化疗药物。本研究旨在探讨真实世界临床实践中接受阿替利珠单抗联合贝伐珠单抗治疗的晚期 HCC 患者早期肿瘤进展（e-PD）与相关因素。
共纳入 184 例接受阿替利珠单抗联合贝伐珠单抗治疗的 HCC 患者。我们分析了 e-PD 的发生频率，并对 e-PD 的危险因素进行了分析。
共有 47 例（25.5%）患者被诊断为 e-PD。与非 e-PD 患者相比，e-PD 患者的体力状态（PS）和白蛋白-胆红素（ALBI）及 Child-Pugh（C-P）评分更差，且系统治疗率更高。多因素分析显示 PS≥1（比值比[OR] = 4.5，95%置信区间[CI] = 1.9-10，p < 0.001）、ALBI 评分≥-2.30（OR = 2.1，95% CI = 1.0-4.5，p = 0.044）和系统治疗史（OR = 3.0，95% CI = 1.4-6.4，p = 0.0038）是 e-PD 的独立危险因素。在观察 e-PD 患者的肝功能趋势时，治疗开始后 3 周和 6 周的 ALBI 评分明显高于治疗前（p < 0.001）。
在真实世界临床实践中，肝功能和系统治疗是阿替利珠单抗联合贝伐珠单抗治疗 HCC 患者发生 e-PD 的有用预测因素。
