Viral Etiology, NLR Lead to Better Responses With Atezolizumab/Bevacizumab Combo in HCC

Patients with unrespectable hepatocellular carcinoma (u-HCC) who were treated with atezolizumab (Tecentriq) plus bevacizumab (Avastin) in the first-line treatment setting achieved better responses when their disease had a viral vs nonviral etiology and neutrophil-to-lymphocyte ratio (NLR) was less than 3.6, according to findings presented at the EASL Liver Cancer Summit 2022. The patients were treated in Japan, where agents approved for first- and second-line therapies can also be used for later-line treatments.¹

“We investigated factors associated with the radiological response of atezolizumab plus bevacizumab for uHCC and the relationship between a-fetoprotein (AFP) and time to progression (TTP),” the investigators wrote in a poster.

To achieve their results, investigators enrolled a total of 81 patients who received the treatment combination at Musashino Red Cross Hospital in Tokyo between October 2020 and November 2021. They performed radiological evaluation at baseline, 6 to 8 weeks after treatment administration, and every 6 to 8 weeks thereafter. Best response was evaluated using RECIST 1.1 criteria.

Among the patients enrolled on the trial, 66 had radiological evaluation. There was an objective response rate (ORR) of 25.8%, and a disease control rate (DCR) of 74.2%. There was no reduction or discontinuation of bevacizumab due to adverse events within 12 weeks that was a significant ORR related factor (P = .02).

The etiology of the 81 patients was most commonly hepatitis C virus (n = 29), followed by other (n = 21), alcohol (n = 17), and hepatitis B virus (n = 14). Fifty-one patients had Barcelona Clinic Liver Cancer (BCLC) stage B, whereas 30 had stage C and none had stage A. The median albumin-bilirubin (ALBI) score was –2.19 (range, –3.28 to –1.37).

The median patient age was 75 years (range, 24-91), and most were men (n = 63). “BCLC stage and ALBI grade were not associated with ORR,” the investigators wrote.

The factors related to DCR were viral etiology and having a baseline ratio (NLR) less than 3.6 (P = .005; P = .008, respectively). Changes in AFP at the 6-week mark may be a predictor of disease progression, the investigators wrote.

Median TTP in the fi rst-line group was not reached. In second-or later-lines, it was 3.8 months (P < .001). The median TTP in patients with an AFP response, defined as reduction of greater than or equal to 20% from baseline at 6 weeks, was 8.8 months and was 4.5 months for those with a nonresponse (P = .003). For the patients with an AFP progression, defined as an increase in greater than or equal to 10% from baseline, the median TTP was 3.8 months, whereas those without progression had a median TTP of 8.7 months (P = .005).

The results indicated that the patients receiving the treatment combination in the first-line setting achieved more promising clinical outcomes than those who were administered the treatment at later lines.

REFERENCE:

1. Hayakawa Y, Yasui Y, Ishido S, et al. Factors associated with the radiological response of atezolizumab plus bevacizumab for unresectable hepatocellular carcinoma. EASL 2022 Liver Cancer Summit poster session 176.