Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.
College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Oncologist. 2024 Jul 5;29(7):e922-e931. doi: 10.1093/oncolo/oyae048.
Atezolizumab plus bevacizumab (atezo-bev) has been recommended for advanced hepatocellular carcinoma (HCC). High-dose external beam radiotherapy (RT) is recognized for its excellent local tumor control. The efficacy and safety of concurrent atezo-bev with RT for highly advanced HCC has been minimally explored.
In this preliminary retrospective study, we assessed patients with highly advanced HCC, characterized by Vp4 portal vein thrombosis or tumors exceeding 50% of liver volume, who received concurrent atezo-bev and RT (group A). Group A included 13 patients who received proton radiation at a dose of 72.6 GyE in 22 fractions, and one patient who received photon radiation at a dose of 54 Gy in 18 fractions. This group was compared with 34 similar patients treated atezo-bev alone as a control (group B). The primary objectives were to evaluate the objective response rate (ORR), overall survival (OS), and safety.
Baseline characteristics were similar between groups, except for a higher incidence of Vp4 portal vein thrombosis in group A (78.6% vs. 21.4%, P = .05). Group A achieved a higher ORR (50.0% vs. 11.8%, P < .01) and a longer OS (not reached vs. 5.5 months, P = .01) after a median follow-up of 5.2 months. Multivariate analysis indicated that concurrent RT independently favored longer OS (hazard ratio: 0.18; 95% CI, 0.05-0.63, P < .01). Group A did not increase any grade adverse events (78.6% vs. 58.8%, P = .19) or severe adverse events of grade ≥ 3 (14.3% vs. 14.7%, P = .97) compared to group B.
The concurrent high-dose external beam radiotherapy appears to safely enhance the effectiveness of atezolizumab plus bevacizumab for highly advanced patients with HCC. Further studies are warranted to confirm these findings.
阿替利珠单抗联合贝伐珠单抗（atezo-bev）已被推荐用于晚期肝细胞癌（HCC）。高剂量外照射放疗（RT）因其出色的局部肿瘤控制效果而得到认可。对于高度晚期 HCC，同步阿替利珠单抗联合 RT 的疗效和安全性尚未得到充分探索。
在这项初步回顾性研究中，我们评估了 Vp4 门静脉血栓形成或肿瘤超过肝脏体积 50%的高度晚期 HCC 患者，这些患者接受了同步阿替利珠单抗联合 RT（A 组）治疗。A 组包括 13 例接受质子放疗，剂量为 72.6 GyE/22 次，1 例接受光子放疗，剂量为 54 Gy/18 次。该组与 34 例接受单纯阿替利珠单抗治疗的相似患者（B 组）进行了比较。主要目标是评估客观缓解率（ORR）、总生存期（OS）和安全性。
两组的基线特征相似，除了 A 组 Vp4 门静脉血栓形成发生率较高（78.6%比 21.4%，P=0.05）。在中位随访 5.2 个月后，A 组的 ORR 更高（50.0%比 11.8%，P<0.01），OS 更长（未达到比 5.5 个月，P=0.01）。多因素分析表明，同步 RT 独立有利于 OS 延长（风险比：0.18；95%CI，0.05-0.63，P<0.01）。与 B 组相比，A 组未增加任何级别不良事件（78.6%比 58.8%，P=0.19）或≥3 级严重不良事件（14.3%比 14.7%，P=0.97）。
高剂量外照射放疗联合阿替利珠单抗联合贝伐珠单抗似乎可安全提高高度晚期 HCC 患者的疗效。需要进一步研究来证实这些发现。
