193P - Impact of coronavirus disease 2019 on patients with unresectable hepatocellular carcinoma treated with atezolizumab/bevacizumab

Background

The coronavirus disease 2019 (COVID-19) pandemic has proven challenging to the management of patients with cancer, particularly those receiving systemic therapy. The aim of this study was to evaluate the impact of COVID-19 on patients with unresectable hepatocellular carcinoma (HCC) treated with atezolizumab/bevacizumab.

Methods

Patients with unresectable HCC who started atezolizumab/bevacizumab treatment between June 2020 and December 2021 at a tertiary cancer center in Korea were included (n=241). The patients were classified according to their COVID-19 status and severity.

Results

Thirty-five (14.5%) patients with unresectable HCC were diagnosed with COVID-19 during atezolizumab/bevacizumab treatment; there were 26 (74.2%) in the low-severity group and nine (25.7%) in the high-severity group. The high-severity group showed higher neutrophil-to-lymphocyte ratios and lactate dehydrogenase levels. Liver and kidney injuries were observed in 31.4% and 17.1% patients, respectively. Patients with impaired liver function at baseline were more susceptible to high-severity COVID-19 and liver injury. Atezolizumab/bevacizumab treatment was delayed by a median of 0 days (range, 0–21) in the low-severity group and 12 days (range, 0–35) in the high-severity group. Treatment strategies were changed for 12 (34.3%) patients because of COVID-19. The high-severity group showed worse post-infection progression-free survival (1.1 vs. 4.8 months, p=0.017) and overall survival (2.2 months vs. not reached, p=0.004).

Conclusions

COVID-19 during atezolizumab/bevacizumab treatment can induce liver or acute kidney injury in some patients with unresectable HCC, leading to treatment delay or discontinuation. Patients with impaired liver function are more susceptible to high-severity COVID-19, which affects atezolizumab/bevacizumab treatment outcomes.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

National Research Foundation of Korea [NRF] grant funded by the Korea government (MSIT).

Disclosure

All authors have declared no conflicts of interest.