Retrospective Multicentre Real-Life Study Evaluating the Efficacy of Atezolizumab Combined with Bevacizumab for the Treatment of Metastatic Hepatocellular Carcinoma: HIREAL Study.
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Abstract
Background: Hepatocellular carcinoma (HCC) is the most common hepatic malignancy and is one of the most prevalent cancers worldwide. The prognosis of late-stage HCC remains poor. The ImBrave 150 trial successfully demonstrated that overall survival (OS) and progression-free survival (PFS) was improved among patients treated with atezolizumab combined with bevacizumab (AB) compared with patients treated with sorafenib. Real-world data are essential to assess the safety and efficacy of new therapies in HCC, given patients' fragility and the heterogeneity of underlying liver diseases.
Objective: The primary objective of this study was to evaluate the OS and PFS of patients with locally advanced or metastatic HCC treated with atezolizumab combined with bevacizumab. The secondary objective was to conduct subgroup analyses to further examine how the effects of the combination treatment differ based on Child‒Pugh scores, prior local treatment, and alpha-fetoprotein (AFP) levels.
Methods: We conducted a multicentric retrospective study. All patients with confirmed locally advanced or metastatic HCC treated with atezolizumab combined with bevacizumab between January 2021 and December 2023 were included.
Results: Seventy patients were included. A total of 76% presented with cirrhosis, among which 85% had Child‒Pugh class A cirrhosis. The cirrhosis cases were mostly nonviral (85.7%). The median OS was 19 months (95% CI: 15-NA), and the median PFS was 6.7 months (95% CI: 4.7-14.2 months). The secondary analysis revealed a statistically significant difference in OS between patients with Child‒Pugh class A cirrhosis and those with Child‒Pugh class B cirrhosis, with median OS durations of 18.9 months (95% CI: 16.9-NA) and 6.0 months (95% CI: 1.5-NA), respectively (p = 0.03). However, the retrospective design and the lack of a control group represent important limitations.
Conclusion: Our real-life study yielded OS and PFS durations similar to those reported in the ImBrave 150 trial.
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