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)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: July 27, 2022
Accepted:
July 11,
2022
Received:
May 17,
2022
Identification
Copyright
© 2022 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
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- Gaining knowledge for the choice and use of systemic therapies in the treatment of hepatocellular carcinoma also requires real life and investigators conducted observational studiesDigestive and Liver DiseaseVol. 54Issue 11
- PreviewIn this issue of Digestive and Liver Disease, ITA.LI.CA. a large, well-known, efficient and productive Italian cooperative group devoted to the study of liver cancer analyzed the theoretical eligibility for the combination of atezolizumab plus bevacizumab among their patients with advanced HCC who received at least one dose of systemic therapy with a tyrosin kinase inhibitor (TKI) [1]. Eligibility was assessed according to the criteria adopted for the IMBRAVE 150 phase 3 registration trial [2] and was found to reach hardly 30% of all patients.
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