Hepatitis C Eradication Improves Oncologic and Clinical Outcomes in Patients Treated With Atezolizumab Plus Bevacizumab

IF 5.2 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Liver International Pub Date : 2025-09-22 DOI:10.1111/liv.70362

Leonardo Stella, Giuseppe Cabibbo, Ciro Celsa, Roberta Ciccia, Alba Sparacino, Fabio Piscaglia, Francesco Tovoli, Andrea Arleo, Bernardo Stefanini, Massimo Iavarone, Roberta D'Ambrosio, Lucia Cerrito, Maria Pallozzi, Francesco Santopaolo, Fabio Marra, Claudia Campani, Chiara Mazzarelli, Raffaella Viganò, Raffaella Tortora, Alessio Aghemo, Stella De Nicola, Tiziana Pressiani, Lorenza Rimassa, Sherrie Bhoori, Salvatore Corallo, Laura Maiocchi, Andrea Martini, Caterina Soldà, Francesco Paolo Russo, Antonio Gasbarrini, Francesca Romana Ponziani

{"title":"Hepatitis C Eradication Improves Oncologic and Clinical Outcomes in Patients Treated With Atezolizumab Plus Bevacizumab","authors":"Leonardo Stella, Giuseppe Cabibbo, Ciro Celsa, Roberta Ciccia, Alba Sparacino, Fabio Piscaglia, Francesco Tovoli, Andrea Arleo, Bernardo Stefanini, Massimo Iavarone, Roberta D'Ambrosio, Lucia Cerrito, Maria Pallozzi, Francesco Santopaolo, Fabio Marra, Claudia Campani, Chiara Mazzarelli, Raffaella Viganò, Raffaella Tortora, Alessio Aghemo, Stella De Nicola, Tiziana Pressiani, Lorenza Rimassa, Sherrie Bhoori, Salvatore Corallo, Laura Maiocchi, Andrea Martini, Caterina Soldà, Francesco Paolo Russo, Antonio Gasbarrini, Francesca Romana Ponziani","doi":"10.1111/liv.70362","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background and Aims</h3>\n \n <p>Hepatitis C virus (HCV) is a key driver of hepatocellular carcinoma (HCC). However, the impact of HCV eradication on systemic therapy remains unclear. We aimed to assess the safety and efficacy of direct-acting antivirals (DAA) in patients treated with Atezolizumab plus Bevacizumab (AtezoBev).</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>This retrospective multicentre study included patients with HCV-related unresectable/advanced HCC treated with AtezoBev between 2021 and 2024. Three groups of patients were compared: Group A (<i>n</i> = 22), concurrent DAA with AtezoBev; Group B (<i>n</i> = 95), antiviral therapy before AtezoBev; and Group C (<i>n</i> = 22), active infection.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Group A showed the longest median overall survival (42.8 months) compared to Group B (26.8 months; <i>p</i> = 0.03) and Group C (19.7 months; <i>p</i> = 0.01). Time to progression and progression-free survival were significantly prolonged in Group A versus Groups B and C. Moreover, Group A exhibited a higher disease control rate than the other groups. Post-DAA decompensation rates were significantly lower in Group A (4.5%) compared to Groups B (26.3%) and C (36.4%). Treatment-related adverse events of grade ≥ 3 were similar across groups. In the multivariate competing risk analysis with adjustment for time-dependent variables, achieving sustained virologic response during AtezoBev showed a protective effect against liver decompensation (sHR 0.02, <i>p</i> = 0.003) or tumour progression (sHR 0.14, <i>p</i> = 0.009), and was also associated with reduced mortality (HR 0.29, <i>p</i> = 0.005).</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>Achieving a SVR during AtezoBev seems to improve oncologic outcomes and reduce liver decompensation in patients with unresectable/advanced HCC. An integrated therapeutic approach can optimise systemic treatment efficacy, particularly in patients eligible for conversion strategies.</p>\n </section>\n \n <section>\n \n <h3> Trial Registration</h3>\n \n <p>Protocol ID: 5890</p>\n </section>\n </div>","PeriodicalId":18101,"journal":{"name":"Liver International","volume":"45 10","pages":""},"PeriodicalIF":5.2000,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/liv.70362","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Liver International","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/liv.70362","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background and Aims

Hepatitis C virus (HCV) is a key driver of hepatocellular carcinoma (HCC). However, the impact of HCV eradication on systemic therapy remains unclear. We aimed to assess the safety and efficacy of direct-acting antivirals (DAA) in patients treated with Atezolizumab plus Bevacizumab (AtezoBev).

Methods

This retrospective multicentre study included patients with HCV-related unresectable/advanced HCC treated with AtezoBev between 2021 and 2024. Three groups of patients were compared: Group A (n = 22), concurrent DAA with AtezoBev; Group B (n = 95), antiviral therapy before AtezoBev; and Group C (n = 22), active infection.

Results

Group A showed the longest median overall survival (42.8 months) compared to Group B (26.8 months; p = 0.03) and Group C (19.7 months; p = 0.01). Time to progression and progression-free survival were significantly prolonged in Group A versus Groups B and C. Moreover, Group A exhibited a higher disease control rate than the other groups. Post-DAA decompensation rates were significantly lower in Group A (4.5%) compared to Groups B (26.3%) and C (36.4%). Treatment-related adverse events of grade ≥ 3 were similar across groups. In the multivariate competing risk analysis with adjustment for time-dependent variables, achieving sustained virologic response during AtezoBev showed a protective effect against liver decompensation (sHR 0.02, p = 0.003) or tumour progression (sHR 0.14, p = 0.009), and was also associated with reduced mortality (HR 0.29, p = 0.005).

Conclusions

Achieving a SVR during AtezoBev seems to improve oncologic outcomes and reduce liver decompensation in patients with unresectable/advanced HCC. An integrated therapeutic approach can optimise systemic treatment efficacy, particularly in patients eligible for conversion strategies.

Trial Registration

Protocol ID: 5890

Abstract Image

查看原文本刊更多论文

阿特唑单抗联合贝伐单抗治疗的丙型肝炎根除改善患者的肿瘤学和临床结果

背景与目的丙型肝炎病毒（HCV）是肝细胞癌（HCC）的关键驱动因子。然而，HCV根除对全身治疗的影响尚不清楚。我们的目的是评估直接作用抗病毒药物（DAA）在Atezolizumab联合贝伐单抗（AtezoBev）治疗的患者中的安全性和有效性。方法本回顾性多中心研究纳入了2021年至2024年间接受AtezoBev治疗的hcv相关不可切除/晚期HCC患者。对三组患者进行比较：A组（n = 22），同时DAA和AtezoBev；B组（n = 95）， AtezoBev前抗病毒治疗；C组22例为活动性感染。结果A组的中位总生存期最长，为42.8个月，B组为26.8个月，p = 0.03， C组为19.7个月，p = 0.01。与B组和c组相比，A组的进展时间和无进展生存期明显延长，而且A组的疾病控制率高于其他组。daa后失代偿率A组（4.5%）明显低于B组（26.3%）和C组（36.4%）。治疗相关不良事件≥3级组间相似。在调整时间相关变量的多变量竞争风险分析中，在AtezoBev期间实现持续的病毒学应答显示出对肝脏失代偿（sHR 0.02, p = 0.003）或肿瘤进展（sHR 0.14, p = 0.009）的保护作用，并且还与降低死亡率（HR 0.29, p = 0.005）相关。结论：在AtezoBev期间达到SVR似乎可以改善肿瘤预后并减少不可切除/晚期HCC患者的肝脏失代偿。综合治疗方法可以优化全身治疗效果，特别是对符合转换策略条件的患者。试验注册协议ID: 5890

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Liver International 医学-胃肠肝病学

CiteScore

13.90

自引率

4.50%

发文量

348

审稿时长

2 months

期刊介绍： Liver International promotes all aspects of the science of hepatology from basic research to applied clinical studies. Providing an international forum for the publication of high-quality original research in hepatology, it is an essential resource for everyone working on normal and abnormal structure and function in the liver and its constituent cells, including clinicians and basic scientists involved in the multi-disciplinary field of hepatology. The journal welcomes articles from all fields of hepatology, which may be published as original articles, brief definitive reports, reviews, mini-reviews, images in hepatology and letters to the Editor.