Takaaki Tanaka1, Atsushi Hiraoka1, Toshifumi Tada2, Masashi Hirooka3, Kazuya Kariyama4, Joji Tani5, Masanori Atsukawa6, Koichi Takaguchi7, Ei Itobayashi8, Shinya Fukunishi9, Kunihiko Tsuji10, Toru Ishikawa11, Kazuto Tajiri12, Hironori Ochi13, Satoshi Yasuda14, Hidenori Toyoda14, Chikara Ogawa15, Takashi Nishimura16, Takeshi Hatanaka17, Satoru Kakizaki18, Noritomo Shimada19, Kazuhito Kawata20, Atsushi Naganuma21, Hisashi Kosaka22, Hideko Ohama9, Kazuhiro Nouso4, Asahiro Morishita5, Akemi Tsutsui7, Takuya Nagano7, Norio Itokawa6, Tomomi Okubo6, Taeang Arai6, Michitaka Imai11, Yohei Koizumi3, Shinichiro Nakamura2, Kouji Joko13, Hiroko Iijima16, Masaki Kaibori22, Yoichi Hiasa3, Masatoshi Kudo23, Takashi Kumada24. 1. Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan. 2. Department of Internal Medicine, Japanese Red Cross Himeji Hospital, Himeji, Japan. 3. Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Japan. 4. Department of Hepatology, Okayama City Hospital, Okayama, Japan. 5. Department of Gastroenterology and Hepatology, Kagawa University, Kagawa, Japan. 6. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Nippon Medical School, Tokyo, Japan. 7. Department of Hepatology, Kagawa Prefectural Central Hospital, Takamatsu, Japan. 8. Department of Gastroenterology, Asahi General Hospital, Asahi, Japan. 9. Department of Gastroenterology, Osaka Medical and Pharmaceutical University, Osaka, Japan. 10. Center of Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan. 11. Department of Gastroenterology, Saiseikai Niigata Hospital, Niigata, Japan. 12. Department of Gastroenterology, Toyama University Hospital, Toyama, Japan. 13. Hepato-biliary Center, Japanese Red Cross Matsuyama Hospital, Matsuyama, Japan. 14. Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Japan. 15. Department of Gastroenterology, Japanese Red Cross Takamatsu Hospital, Takamatsu, Japan. 16. Department of Gastroenterology and Hepatology, Hyogo College of Medicine, Nishinomiya, Japan. 17. Department of Gastroenterology, Gunma Saiseikai Maebashi Hospital, Gunma, Japan. 18. Department of Clinical Research, National Hospital Organization Takasaki General Medical Center, Takasaki, Japan. 19. Division of Gastroenterology and Hepatology, Otakanomori Hospital, Kashiwa, Japan. 20. Hepatology Division, Department of Internal Medicine II, Hamamatsu University School of Medicine, Hamamatsu, Japan. 21. Department of Gastroenterology, National Hospital Organization Takasaki General Medical Center, Takasaki, Japan. 22. Department of Surgery, Kansai Medical University, Hirakata, Japan. 23. Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan. 24. Department of Nursing, Gifu Kyoritsu University, Ogaki, Japan.
Abstract
BACKGROUND/AIM: Atezolizumab plus bevacizumab (Atez/Bev) treatment is recommended for unresechepatocellular carcinoma (u-HCC) patients classified as Child-Pugh A (CP-A). This study aimed to elucidate the prognosis of patients treated with Atez/Bev, especially CP-A and -B cases. MATERIALS/ METHODS: From September 2020 to March 2022, 457 u-HCC patients treated with Atez/Bev were enrolled (median age 74 years, male:female = 368:89, CP-A:CP-B = 427:30, Child-Pugh score [CPS] 5:6:7:8:9 = 271:156:21:8:1). Therapeutic response was evaluated using RECIST ver.1.1. Clinical features and prognosis were retrospectively evaluated. RESULTS: There were no significant differences between CP-A and -B patients in regard to best response (CR:PR:SD:PD = 16:91:194:81 vs. 0:7:13:8, p = 0.739; objective response rate/disease control rate = 28.0%/78.8% vs. 25.0%/71.4%). Analysis performed using inverse probability weighting adjustments of clinical factors other than those related to hepatic reserve function with a p value < 0.10 for comparisons between patients with CP-A and -B showed that the progression-free survival (PFS) rate for CP-A cases was better (6-/12-/18-month: 58.2%/36.1%/27.8% vs. 49.6%/8.7%/non-estimable [NE], p < 0.001), as was overall survival (OS) rate (6-/12-/18-month: 89.9%/71.7%/51.4% versus 63.6%/18.4%/NE; p < 0.001). Median PFS (mPFS) and median OS (mOS) for the CPS-5 were 9.5 months/NE, and 5.1/14.0 months for the CPS-6 (both p < 0.001). Furthermore, for modified albumin-bilirubin grade (mALBI)-1/2a/2b, mPFS was 9.4/8.5/5.3 months (p < 0.001) and mOS was NE/17.8/13.4 months (p < 0.001). CONCLUSION: Better hepatic function, such as mALBI grade 1 or 2a are thought to indicate a better condition for obtaining sufficient prognosis with Atez/Bev treatment for u-HCC patients, whereas for CP-B patients, who mainly shown an mALBI grade of 2b or 3, Atez/Bev might have less therapeutic efficacy.
BACKGROUND/AIM: Atezolizumab plus bevacizumab (Atez/Bev) treatment is recommended for unresechepatocellular carcinoma (u-HCC) patients classified as Child-Pugh A (CP-A). This study aimed to elucidate the prognosis of patients treated with Atez/Bev, especially CP-A and -B cases. MATERIALS/ METHODS: From September 2020 to March 2022, 457 u-HCC patients treated with Atez/Bev were enrolled (median age 74 years, male:female = 368:89, CP-A:CP-B = 427:30, Child-Pugh score [CPS] 5:6:7:8:9 = 271:156:21:8:1). Therapeutic response was evaluated using RECIST ver.1.1. Clinical features and prognosis were retrospectively evaluated. RESULTS: There were no significant differences between CP-A and -B patients in regard to best response (CR:PR:SD:PD = 16:91:194:81 vs. 0:7:13:8, p = 0.739; objective response rate/disease control rate = 28.0%/78.8% vs. 25.0%/71.4%). Analysis performed using inverse probability weighting adjustments of clinical factors other than those related to hepatic reserve function with a p value < 0.10 for comparisons between patients with CP-A and -B showed that the progression-free survival (PFS) rate for CP-A cases was better (6-/12-/18-month: 58.2%/36.1%/27.8% vs. 49.6%/8.7%/non-estimable [NE], p < 0.001), as was overall survival (OS) rate (6-/12-/18-month: 89.9%/71.7%/51.4% versus 63.6%/18.4%/NE; p < 0.001). Median PFS (mPFS) and median OS (mOS) for the CPS-5 were 9.5 months/NE, and 5.1/14.0 months for the CPS-6 (both p < 0.001). Furthermore, for modified albumin-bilirubin grade (mALBI)-1/2a/2b, mPFS was 9.4/8.5/5.3 months (p < 0.001) and mOS was NE/17.8/13.4 months (p < 0.001). CONCLUSION: Better hepatic function, such as mALBI grade 1 or 2a are thought to indicate a better condition for obtaining sufficient prognosis with Atez/Bev treatment for u-HCC patients, whereas for CP-B patients, who mainly shown an mALBI grade of 2b or 3, Atez/Bev might have less therapeutic efficacy.