Mild liver function decline in patients treated with atezolizumab and bevacizumab for hepatocellular carcinoma: a real-world study.

Background: Atezolizumab plus bevacizumab is recommended as first-line systemic therapy for patients with advanced hepatocellular carcinoma (HCC). This study aimed to investigate the prognostic significance of early mild liver function deterioration in a real-world cohort.

Methods: This retrospective study included patients with HCC treated with atezolizumab plus bevacizumab as first-line between September 2020 and January 2024. We evaluated the evolution of liver function during the first 6 months of treatment, survival, and adverse events, and the impact of mild deterioration [change in albumin-bilirubin (ALBI) grade, without clinical ascites, encephalopathy, jaundice, or gastrointestinal bleeding] on overall survival (OS).

Results: Among 155 patients, 44 had a Child-Pugh score ⩾ B7, and 111 had ALBI grade ⩾ 2 at baseline. Median OS was 24.1 months. There was a significant deterioration in the ALBI score at cycle 2 (P = 0.001), 3 (P = 0.001), and 4 (P = 0.015), with no deterioration in the subsequent treatment. In multivariate analyses, baseline ALBI grade 3 (vs. 1), Eastern Cooperative Oncology Group 1 (vs. 0), macrovascular invasion, but not mild deterioration of liver function, were identified as independent prognostic predictors for OS.

Conclusion: Early mild liver function deterioration does not impact OS during first-line treatment with atezolizumab and bevacizumab.