Febro Rene John D, Perillo Engelbert Simon S, Kimura Akemi A, Wong Stephen N
Section of Gastroenterology, University of Santo Tomas Hospital, Manila, Philippines.
J Liver Cancer. 2024 Sep;24(2):234-242. doi: 10.17998/jlc.2024.05.23. Epub 2024 Jun 3.
BACKGROUNDS/AIMS: Atezolizumab/bevacizumab is the recommended first-line systemic therapy for unresectable hepatocellular carcinoma (uHCC) and may facilitate curative conversion through resection and locoregional therapies. However, there have been very few reports on curative conversion using microwave ablation (MWA). This study aimed to determine the curative conversion rate with MWA using atezolizumab-bevacizumab as the first-line treatment in patients with uHCC, and to compare the characteristics and survival of patients with and without curative conversion.
Consecutive patients with uHCC who were started on atezolizumab-bevacizumab from May 2021 to December 2023 in a single tertiary center were included. Objective response rate (ORR) and disease control rate (DCR) were based on the Response Evaluation Criteria In Solid Tumors (RECIST) 1.1 and modified RECIST (mRECIST) criteria.
Twenty consecutive patients with uHCC (60% advanced-stage) were included, 90% exceeding the up-to-7 criteria. The ORR and DCR were 35% and 60%, 35% and 55% using RECIST and mRECIST, respectively. Five patients (25%) underwent successful curative conversion with MWA (four advanced and one intermediate stage) despite a median HCC size of 6.1 cm (range, 2.4-7.3). Two of these patients were tumor and drug-free 132-133 weeks from the 1st atezolizumab-bevacizumab dose. Patients who underwent curative conversion had significantly longer survival than those who did not (P=0.024). Other factors associated with survival were male sex, Child-Pugh class A, and an objective response.
Despite the relatively large tumor size, successful curative conversion with MWA was achieved with first-line atezolizumab-bevacizumab in uHCC. However, data from prospective multicenter trials are required to determine whether this strategy is universally applicable.
背景/目的：阿替利珠单抗/贝伐珠单抗是不可切除肝细胞癌（uHCC）推荐的一线全身治疗方案，可能有助于通过手术切除和局部区域治疗实现治愈性转化。然而，关于使用微波消融（MWA）实现治愈性转化的报道非常少。本研究旨在确定以阿替利珠单抗-贝伐珠单抗作为一线治疗的uHCC患者使用MWA后的治愈性转化率，并比较实现和未实现治愈性转化患者的特征及生存情况。
纳入2021年5月至2023年12月在单个三级中心开始接受阿替利珠单抗-贝伐珠单抗治疗的连续性uHCC患者。客观缓解率（ORR）和疾病控制率（DCR）基于实体瘤疗效评价标准（RECIST）1.1和改良RECIST（mRECIST）标准。
纳入20例连续性uHCC患者（60%为晚期），90%超过了7项及以下标准。使用RECIST和mRECIST标准时，ORR分别为35%和60%，DCR分别为35%和55%。5例患者（25%）通过MWA成功实现治愈性转化（4例晚期和1例中期），尽管肝癌中位大小为6.1 cm（范围2.4 - 7.3 cm）。其中2例患者从首次使用阿替利珠单抗-贝伐珠单抗剂量起132 - 133周时无肿瘤且未用药。实现治愈性转化的患者生存时间显著长于未实现转化的患者（P = 0.024）。与生存相关的其他因素包括男性、Child-Pugh A级和客观缓解。
尽管肿瘤相对较大，但在uHCC患者中，一线使用阿替利珠单抗-贝伐珠单抗联合MWA成功实现了治愈性转化。然而，需要前瞻性多中心试验的数据来确定该策略是否普遍适用。
