Outcomes and safety of atezolizumab plus bevacizumab in the treatment of hepatocellular carcinoma: treatment prognosis and comparison with tyrosine kinase inhibitors in a French multicenter matched real-life study.

IF 2.3 4区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY
Xavier Adhoute, Alexia Gonzalez, Thomas Levi-Strauss, Laurent Mineur, Guillaume Pénaranda, Floriane Sellier, Clémence Toullec, Olivia Pietri, Paul Castellani, Albert Tran, Hervé Perrier, Marc Bourliere, Rodolphe Anty
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Abstract

Background and aims: The combination of atezolizumab plus bevacizumab (Atz/Bev) has radically changed the treatment strategy for advanced hepatocellular carcinoma (HCC) but raises questions. Our objectives were to determine survival outcomes and safety in a real-life multicenter French cohort, to investigate the on-treatment prognostic value of the bioinflammatory RECA score, and to perform a matched comparison with patients who previously received tyrosine kinase inhibitors (TKIs).

Methodology: A retrospective analysis of 109 consecutive patients enrolled from September 2020 to January 2023 and a post matched comparison with a TKI cohort ( n  = 79) by the propensity score matching method.

Results: The Atz/Bev population was mainly nonviral disease patients (69%) with Child-Pugh grade A (90%), performance status 0/1 (90%), and Barcelona Clinic Liver Cancer stage B (38%) or stage C (62%) classification. After a median follow-up of 6.5 months (3.6-11.7), overall survival (OS) was 13.0 (5.1-28.7) months. OS was independently associated with metastasis, increased alkaline phosphatase, and serum bilirubin levels. Treatment-related adverse events were reported in 78% of patients, mostly grade 1 or 2. The RECA score clearly revealed two different prognosis groups after three cycles. No difference in OS was observed after matching between sequential treatment with TKIs and Atz/Bev.

Conclusion: This real-life study highlights the importance of liver function when using Atz/Bev combination and the necessity of identifying predictive markers of response to HCC therapies. Our findings suggest a change in practices, with a marked proportion of intermediate stages, and support the on-treatment prognostic value of an inflammatory score.

阿特珠单抗联合贝伐单抗治疗肝细胞癌的疗效和安全性:法国一项多中心匹配真实研究中的治疗预后以及与酪氨酸激酶抑制剂的比较。
背景和目的:阿特珠单抗联合贝伐单抗(Atz/Bev)从根本上改变了晚期肝细胞癌(HCC)的治疗策略,但也提出了一些问题。我们的目标是在一个真实的法国多中心队列中确定生存结果和安全性,研究生物炎症RECA评分的治疗预后价值,并与之前接受过酪氨酸激酶抑制剂(TKIs)治疗的患者进行配对比较:对2020年9月至2023年1月连续入组的109例患者进行回顾性分析,并通过倾向得分匹配法与TKI队列(n = 79)进行匹配后比较:Atz/Bev患者主要为非病毒性疾病患者(69%),Child-Pugh分级为A级(90%),表现状态为0/1(90%),巴塞罗那临床肝癌分期为B期(38%)或C期(62%)。中位随访时间为6.5个月(3.6-11.7),总生存期(OS)为13.0个月(5.1-28.7)。OS与转移、碱性磷酸酶和血清胆红素水平升高密切相关。78%的患者报告了与治疗相关的不良反应,大部分为1级或2级。RECA评分清楚地显示了三个周期后两个不同的预后组。TKIs和Atz/Bev序贯治疗匹配后,未观察到OS差异:这项真实的研究强调了使用 Atz/Bev 联合疗法时肝功能的重要性,以及确定 HCC 治疗反应预测指标的必要性。我们的研究结果表明,治疗方法发生了变化,中期患者的比例明显增加,并支持炎症评分在治疗预后方面的价值。
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来源期刊
CiteScore
4.40
自引率
4.80%
发文量
269
审稿时长
1 months
期刊介绍: European Journal of Gastroenterology & Hepatology publishes papers reporting original clinical and scientific research which are of a high standard and which contribute to the advancement of knowledge in the field of gastroenterology and hepatology. The journal publishes three types of manuscript: in-depth reviews (by invitation only), full papers and case reports. Manuscripts submitted to the journal will be accepted on the understanding that the author has not previously submitted the paper to another journal or had the material published elsewhere. Authors are asked to disclose any affiliations, including financial, consultant, or institutional associations, that might lead to bias or a conflict of interest.
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