Real-world evidence on the efficacy of atezolizumab and bevacizumab in unresectable hepatocellular carcinoma: An institutional experience.

e14594Background: The incidence and mortality rates of primary liver malignancies continue to rise, with hepatocellular carcinoma (HCC) being the most prevalent form of liver cancer. Atezolizumab (atezo), an immune checkpoint inhibitor (ICI), targets proteins that regulate immune responses, known as immune checkpoints. Following the FDA approval of the atezo and bevacizumab (bev) combination as a first-line treatment for HCC, there has been growing interest in exploring its safe application in other treatment settings. This report evaluates the survival outcomes of atezo/bev in patients with unresectable HCC (uHCC) at a single institution. Methods: Patients with uHCC who received atezo/bev as part of their treatment regimen between September 2020 and July 2024 at the Houston Methodist Neal Cancer Center were included in this study. Patients were stratified into two groups: those receiving atezo/bev as first-line therapy and those receiving it as subsequent-line therapy. Survival outcomes, including the number of treatment cycles, median overall survival (OS), and progression-free survival (PFS), were compared between the groups. Kaplan-Meier methodology was used to analyze these outcomes. Results: Of 1,231 patients reviewed, 87 were treated with atezo/bev for uHCC. Among these, 70 patients received atezo/bev as first-line therapy (median age = 68.5 years), and 17 patients received it as subsequent-line therapy (median age = 60 years). Baseline clinical characteristics showed that the first-line group had a median albumin level of 3.5 g/dL, compared to 2.9 g/dL in the subsequent-line group. Liver function tests indicated a median ALT of 32 vs. 36, AST of 54 vs. 63, ALP of 152 vs. 160, bilirubin of 0.6 vs. 0.9, and INR of 1.135 vs. 1.2 for the first-line and subsequent-line groups, respectively. According to the Barcelona Clinic Liver Criteria (BCLC), 7 patients in the first-line group were classified as stage A, 14 as stage B, and 49 as stage C. In the subsequent-line group, 1 patient was stage A, 4 were stage B, and 10 were stage C. The median PFS was 11.31 months for the first-line group and 5.92 months for the subsequent-line group (p = 0.087). The median OS was 16 months for the first-line group and 11 months for the subsequent-line group (p = 0.417). Conclusions: This institutional study suggests that patients with uHCC treated with atezo/bev show longer OS and PFS when treated with the combination as first-line therapy compared to subsequent-line therapy. Although the differences in survival outcomes between the groups were not statistically significant, the data imply a potential clinical benefit from earlier intervention with atezo/bev. These findings warrant further investigation to confirm the observed trends and to identify predictive factors that could improve patient selection and response.