Abstract 243P
Background
Atezolizumab plus bevacizumab (Ate+Beva) proved better efficacy compared to sorafenib as a first line systemic therapy for advanced hepatocellular carcinoma (HCC). However, there is no data about prognosis after discontinuation of Ate+Beva therapy and clinical factor to predict survival. In south Korea, almost all patients have no choice but to discontinue Ate+Beva therapy because national medical insurance cover Ate+Beva therapy for only 2 years. Therefore we can describe clinical course of patients after discontinuation of Ate+Beva therapy and try to find clinical factor to predict survival.
Methods
The clinical course of patients with advanced HCC who received Ate+Beva therapy in single cancer center from September 2020 to February 2024 was assessed. Overall response rate (ORR) (complete response [CR] + partial response [PR]) and disease control rate (DCR) (ORR + stable disease [SD]) per RECIST v1.1 and mRECIST, median overall survival (OS) were analyzed. Especially we divided 12 patients who have tumor response for 2 years as three groups (SD vs PR vs CR) at the time of discontiuation and analyzed progression free survival (PFS) of three groups.
Results
221 patients were treated with Ate+Beva therapy. Child A:B:C patients were 204:16:1, BCLC stage B:C patients were 27:194. Median OS of total patients was 11.8 months. ORR & DCR of total patients were 24.7%, 75.2%. Severe adverse event (SAE) beyond grade 3 was 9.9%. AE of grade 5 (hemoptysis, pneumonitis, variceal bleeding, duodenal ulcer perforation, autoimmune hepatitis) was 2.7%. Tumor response at the time of discontinuation of Ate+Beva were SD in 4 patients, PR in 4 patients, CR in 4 patients. Median PFSs of SD and other groups were significantly different (SD/PR, 2/4 months, p = 0.019; SD/CR, 2/5 months, p = 0.043), but that of PR and CR was not significantly different (PR/CR, 4/5 months, p = 0.181). Tumor markers at the time of discontinuation were not significantly different between three groups.
Conclusions
This study demonstrates that SD at the time of discontinuation of Ate+Beva therapy is associated poor PFS. Therefore we have to consider extension of Ate+Beva therapy if tumor reponse at the time of discontinuation is SD.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The author.
Funding
Has not received any funding.
Disclosure
The author has declared no conflicts of interest.