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Potential feasibility of atezolizumab-bevacizumab therapy in patients with hepatocellular carcinoma treated with tyrosine-kinase inhibitors

      Abstract

      Background

      The combination of atezolizumab-bevacizumab has been proven to be superior to sorafenib for the treatment of unresectable hepatocellular carcinoma not amenable to locoregional treatments, becoming the standard of care of systemic therapy.

      Aim

      This study aimed at assessing real-world feasibility of atezolizumab-bevacizumab in patients treated with tyrosine-kinase inhibitors.

      Methods

      Among 1447 patients treated with tyrosine-kinase inhibitors from January 2010 to December 2020, we assessed the percentage of those potentially eligible to atezolizumab-bevacizumab (according to IMbrave-150 trial criteria), and the overall survival of eligible and non-eligible patients.

      Results

      422 (29%) patients were qualified for atezolizumab-bevacizumab therapy. The main exclusion causes were Child-Pugh class and Performance Status. Adopting the more permissive inclusion criteria of SHARP trial, 535 patients became eligible. The median overall survival of tyrosine-kinase inhibitors patients was 14.9 months, longer in eligible patients than in their counterpart due to better baseline liver function and oncological features.

      Conclusion

      Real-world data indicate that less than one-third of hepatocellular carcinoma patients treated with tyrosine-kinase inhibitors are potentially eligible to atezolizumab-bevacizumab according to the registration trial criteria. These patients have a longer survival than the non-eligible ones. If the selection criteria of atezolizumab-bevacizumab trial are maintained in clinical practice, tyrosine-kinase inhibitors will remain the most used systemic therapy for hepatocellular carcinoma patients.

      Keywords

      Abbreviations:

      HCC (Hepatocellular carcunoma), Atezo-Beva (Atezolizumab-bevacizumab), OS (Overal survival), PFS (Pregression free survival), TKI (Tyrosine-kinasi inhibtor), Durva-Treme (Durvalumab-Tremelimimab), PDL-1 (anti-Programmed Death Ligand protein 1), CTLA-4 (anti-Cytotoxic T-Lmphocyte-Associated protein 4), AFP (Alpha1-fetoprotein), MELD (Model of End Liver Disease), BCLC (Barcelona Clinic Liver Cancer), TAE (Transarterial embolization), TACE (Transarterial chemoembolization), TARE (Transarterial radioembolization)
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