Abstract 975P
Background
In systemic therapy for unresectable HCC (u-HCC), atezolizumab plus bevacizumab (Atez+Bev) has become a standard first-line therapy. Although previous studies already reported predictive biomarkers, including neutrophil-lymphocyte ratio (NLR), CRP, and IL-6, there are no established markers in real-world practice. Urinary protein creatinine ratio (UPCR) was reported to be associated with IL-6. We investigated universal predictive markers in the early phase after the administration of Atez+Bev.
Methods
A total of 134 patients who received Atez+Bev at our institution between Oct 2020 and Mar 2023 were enrolled. Tumor assessments by RECIST v1.1 were done using dynamic CT or MRI every 6-12 weeks. Blood and urine examinations, including UPCR and AFP, were performed every 3 weeks. All clinical information was analyzed retrospectively.
Results
The median age of the patients was 74 years, and the median ALBI score was -2.24. The line of treatment was 1st (n=84) and 2nd or later line (n=50). Seventy-eight (58%) patients were BCLC stage B, and 56 were stage C. The median follow-up duration was 11.2 months. The median overall survival (OS) was 24.5 months in 1st line and 21.8 months in 2nd or later line. The median progression-free survival (PFS) was significantly longer in 1st line than in 2nd or later line (8.2 vs. 4.2 months, p=0.01). The independent factors significantly associated with OS were pretreatment ALBI score (HR 4.8, 95%CI 2.2-10.4, p<.0001) and AFP ≥ 400ng/mL (HR 2.6, 95%CI 1.4-5.0, p=0.003). The independent factors associated with PFS in 1st line were AFP decrease at 6 weeks (HR 0.41, 95%CI 0.2-0.9, p=0.03) and UPCR at 6 weeks (HR 1.3, 95%CI 1.3-2.8, p=0.002). Among the 1st-line patients with stable disease at 6-12 weeks (n=36), the patients with low UPCR (<0.24) at 6 weeks (N=27) had significantly longer PFS than those with high UPCR (11.3 vs. 4.6 months, p=0.02). The dose of Bev within 12 weeks was not significantly different between the two groups.
Conclusions
The assessments of early changes in UPCR and AFP during Atez+Bev were valuable. The therapeutic strategies for patients with stable disease at 6-12 weeks would be considered based on the changes in UPCR and AFP at 6 weeks.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
Masayuki Kurosaki.
Funding
Has not received any funding.
Disclosure
K. Tsuchiya: Financial Interests, Personal, Invited Speaker: Chugai, Eisai, Takeda, Eli Lilly. M. Kurosaki: Financial Interests, Personal, Invited Speaker: Chugai, Eisai, Takeda, Eli Lilly, Bayer, AstraZeneca. N. Izumi: Financial Interests, Personal, Invited Speaker: Chugai, Eisai, Takeda, Eli Lilly, Bayer, AstraZeneca. All other authors have declared no conflicts of interest.
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