Department of Medical Oncology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea.
Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea.
Liver Int. 2024 Aug;44(8):1961-1970. doi: 10.1111/liv.15935. Epub 2024 Apr 15.
Anti-programmed death 1 (PD-1) monotherapy triggers various responses by each organ. In advanced hepatocellular carcinoma (HCC), while extrahepatic lesions demonstrate objective response rates (ORR) of 20%-40%, only 10% of intrahepatic lesions respond. Although first-line atezolizumab/bevacizumab has shown survival benefits in advanced HCC, organ-specific responses remain unexplored. Therefore, we aimed to assess organ-specific responses in patients with advanced HCC receiving atezolizumab/bevacizumab.
This retrospective, multicenter, observational study included patients who received first-line atezolizumab/bevacizumab for advanced HCC. Patients with Child-Pugh class A, measurable tumour lesions and serial imaging available for response evaluation were eligible.
Between May 2020 and June 2021, 131 patients (median age: 62) from three cancer referral institutions were included. Ninety-one had hepatitis B (69.5%), 108 were at Barcelona clinic liver cancer stage C (82.4%), and 78 had extrahepatic metastasis (59.5%). After a median follow-up of 10.1 months, median progression-free survival was 6.8 months (95% confidence interval [CI], 4.6-9.2), median overall survival remained unreached (95% CI, range unavailable) and the ORR was 29.0%. Among 270 individual tumour lesions, the liver was the most commonly involved organ (n = 158). Atezolizumab/bevacizumab induced ORR of 27.8%, 42.2%, 29.1% and 21.0% for liver, lymph nodes, lungs and other sites, respectively. The organ-specific response rate for intrahepatic tumours decreased with increasing size (35.6%: <5 cm, 15.0%: ≥ 5 cm).
Unlike anti-PD-1 monotherapy, atezolizumab/bevacizumab demonstrated favourable responses in intrahepatic lesions, comparable to those in extrahepatic lesions, and may potentially overcome the immune-tolerant hepatic microenvironment in patients with advanced HCC.
抗程序性死亡 1（PD-1）单药治疗可引发各器官的不同反应。在晚期肝细胞癌（HCC）中，虽然肝外病变的客观缓解率（ORR）为 20%-40%，但只有 10%的肝内病变有反应。虽然一线阿替利珠单抗/贝伐珠单抗在晚期 HCC 中显示出生存获益，但器官特异性反应仍未得到探索。因此，我们旨在评估接受阿替利珠单抗/贝伐珠单抗治疗的晚期 HCC 患者的器官特异性反应。
这是一项回顾性、多中心、观察性研究，纳入了接受一线阿替利珠单抗/贝伐珠单抗治疗的晚期 HCC 患者。符合条件的患者为 Child-Pugh 分级为 A，有可测量的肿瘤病变，且有连续的影像学检查可供反应评估。
2020 年 5 月至 2021 年 6 月，来自三家癌症转诊机构的 131 名患者（中位年龄：62 岁）入组。91 名患者患有乙型肝炎（69.5%），108 名患者为巴塞罗那临床肝癌分期 C（82.4%），78 名患者有肝外转移（59.5%）。中位随访 10.1 个月后，中位无进展生存期为 6.8 个月（95%置信区间[CI]：4.6-9.2），中位总生存期仍未达到（95%CI：范围不可用），ORR 为 29.0%。在 270 个单独的肿瘤病变中，肝脏是最常见的受累器官（n=158）。阿替利珠单抗/贝伐珠单抗诱导的肝脏、淋巴结、肺部和其他部位的肿瘤 ORR 分别为 27.8%、42.2%、29.1%和 21.0%。肝内肿瘤的器官特异性反应率随肿瘤大小的增加而降低（35.6%：<5cm，15.0%：≥5cm）。
与抗 PD-1 单药治疗不同，阿替利珠单抗/贝伐珠单抗在肝内病变中显示出良好的反应，与肝外病变相当，并且可能潜在地克服了晚期 HCC 患者的免疫耐受的肝微环境。
