989P - Disease etiology and efficacy outcomes with atezolizumab plus bevacizumab (atezo-bev) in patients (pts) with unresectable hepatocellular carcinoma (uHCC): Multinational retrospective analysis

Background

Atezo-Bev is the one of the standard first-line treatments for pts with uHCC. There have been controversies that the efficacy of immune checkpoint inhibitors might be affected by the etiology of HCC. We performed a multinational retrospective study to investigate the impact of disease etiology on the efficacy outcomes with atezo-bev and prognostic factors in real-world uHCC pts treated with first line atezo-bev.

Methods

A total of 161 pts with Child A liver function who received first-line atezo-bev were included in the current analysis from Asan Medical Center (Seoul, Korea), and National Cancer Centre Singapore (Singapore), between July 2016 and July 2022. Pts with Child B liver function or prior systemic therapy were excluded. Tumor response was assessed per RECIST v1.1.

Results

The median age of the pts was 63 years (range, 16-90) and 136 pts (84.5%) were male. The most common etiology was hepatitis B virus (67.0%), followed by non-alcoholic fatty liver disease (NAFLD) (13.0%), alcohol (7.4%) and hepatitis C virus (4.3%). The objective response rate (ORR) of all pts was 23.6%. There was no difference in ORR based on etiology (viral vs non-viral, 22.1% vs 23.1%; NAFLD vs others, 21.1% vs 23.9%). With a median follow-up of 10.9 months(mo) (95% CI, 9.7-13.1), the median progression-free survival (PFS) and overall survival (OS) were 4.1 mo (95% CI, 3.1-6.9) and 14.0 mo (95% CI, 11.2-18.5), respectively. Median PFS and OS did not differ based on etiology (viral vs non-viral; PFS 4.4 vs 4.4 mo and OS, 14.0 vs 13.1 mo; NAFLD vs others; PFS 3.1 vs 4.1 mo and OS, 14.2 vs 14.0 mo). In the multivariable analysis, higher baseline NLR (≥2.5 [median]) was significantly associated with poorer PFS (median 3.8 vs 9.5 mo, HR 2.2, p=0.003) and OS (median 8.8 vs 27.0 mo, HR 5.0, p<0.001) compared to baseline NLR < 2.5. The most common adverse events (any grade) was hypertension (27.3%), followed by thrombocytopenia (16.9%), proteinuria (11.5%), and hemorrhage (11.5%).

Conclusions

Current study showed that disease etiology was not associated with the efficacy outcomes with first line atezo-bev in pts with uHCC, while higher NLR was a significant poor prognostic factor for these patients.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

D.W.M. Tai: Financial Interests, Institutional, Advisory Board: Novartis, celgene, SIRTEX, MSD, BMS, Eisai, Bayer. C. Yoo: Financial Interests, Personal, Invited Speaker: Bayer, Celgene, Eisai, Ipsen, Servier, Roche, Novartis; Financial Interests, Personal, Advisory Board: AstraZeneca; Financial Interests, Personal, Research Grant: AstraZeneca, Bayer, Servier; Financial Interests, Institutional, Research Grant: Genentech. All other authors have declared no conflicts of interest.