Kulkarni Anand V, Kumaraswamy Parthasarathy, Menon Balachandran, Sekaran Anuradha, Rambhatla Anuhya, Iyengar Sowmya, Alla Manasa, Venishetty Shantan, Ramachandra Sumana Kolar, Premkumar Giri V, Sharma Mithun, Rao P Nagaraja, Reddy Duvvur Nageshwar, Singal Amit G
Department of Hepatology, AIG Hospitals, Hyderabad, India.
Department of Liver Transplant Surgery, AIG Hospitals, Hyderabad, India.
J Liver Cancer. 2024 Sep;24(2):224-233. doi: 10.17998/jlc.2024.05.12. Epub 2024 May 27.
BACKGROUNDS/AIMS: Hepatocellular carcinoma (HCC) is generally diagnosed at an advanced stage, which limits curative treatment options for these patients. Locoregional therapy (LRT) is the standard approach to bridge and downstage unresectable HCC for liver transplantation (LT). Atezolizumab-bevacizumab (atezo-bev) can induce objective responses in nearly one-third of patients; however, the role and outcomes of downstaging using atezo-bev remains unknown.
In this retrospective single-center study, we included consecutive patients between November 2020 and August 2023, who received atezo-bev with or without LRT and were subsequently considered for resection/LT after downstaging.
Of the 115 patients who received atezo-bev, 12 patients (10.4%) achieved complete or partial response and were willing to undergo LT; they (age, 58.5 years; women, 17%; Barcelona Clinic Liver Cancer stage system B/C, 5/7) had received 3-12 cycles of atezo- bev, and four of them had received prior LRT. Three patients died before LT, while three were awaiting LT. Six patients underwent curative therapies: four underwent living donor LT after a median of 79.5 days (range, 54-114) following the last atezo-bev dose, one underwent deceased donor LT 38 days after the last dose, and one underwent resection. All but one patient had complete pathologic response with no viable HCC. Three patients experienced wound healing complications, and one required re-exploration and succumbed to sepsis. After a median follow-up of 10 months (range, 4-30), none of the alive patients developed HCC recurrence or graft rejection.
Surgical therapy, including LT, is possible after atezo-bev therapy in well-selected patients after downstaging.
背景/目的：肝细胞癌（HCC）通常在晚期被诊断出来，这限制了这些患者的治愈性治疗选择。局部区域治疗（LRT）是为肝移植（LT）桥接和降低不可切除HCC分期的标准方法。阿替利珠单抗-贝伐珠单抗（阿替-贝伐）可使近三分之一的患者产生客观反应；然而，使用阿替-贝伐进行降期的作用和结果仍不清楚。
在这项回顾性单中心研究中，我们纳入了2020年11月至2023年8月期间连续接受阿替-贝伐治疗（无论是否联合LRT）且在降期后随后考虑进行切除/LT的患者。
在115例接受阿替-贝伐治疗的患者中，12例（10.4%）实现了完全或部分缓解并愿意接受LT；他们（年龄58.5岁；女性占17%；巴塞罗那临床肝癌分期系统B/C期，5/7例）接受了3 - 12个周期的阿替-贝伐治疗，其中4例曾接受过LRT。3例患者在LT前死亡，3例在等待LT。6例患者接受了根治性治疗：4例在最后一剂阿替-贝伐治疗后中位79.5天（范围54 - 114天）接受了活体供肝LT，1例在最后一剂后38天接受了尸体供肝LT，1例接受了切除手术。除1例患者外，所有患者均有完全病理缓解，无存活的HCC。3例患者出现伤口愈合并发症，1例需要再次探查并死于败血症。中位随访10个月（范围4 - 30个月）后，所有存活患者均未出现HCC复发或移植物排斥反应。
在精心挑选的患者中，降期后接受阿替-贝伐治疗后进行包括LT在内的手术治疗是可行的。
