Efficacy of atezolizumab–bevacizumab combination therapy early after recurrence of hepatocellular carcinoma following resection or ablation with a curative intent

Abstract

Background The pattern of hepatocellular carcinoma (HCC) recurrence after resection/ablation is intrahepatic and/or systemic. The efficacy of atezolizumab–bevacizumab treatment as early therapy after recurrence has not been extensively evaluated.

Methods We evaluated 32 patients (group A) with early HCC recurrence after resection/ablation and 24 patients (group B) initially diagnosed as Barcelona Clinic Liver Cancer (BCLC)-C, all treated with atezolizumab–bevacizumab. Group A was subdivided in group A1 (progression to BCLC-C, n=14) and group A2 (progression to BCLC-B, n=18).

Results Groups A1/A2 were comparable for all baseline parameters. Objective response was observed in 14.3% and 33.3% of patients in groups A1 and A2, respectively. Median overall survival (OS) was impressive and comparable between the 2 groups (22 and 26 months, respectively, P=0.71), as was median progression-free survival (PFS) (15 and 6 months, respectively, P=0.126). Patients categorized in the advanced stage (groups A1/B) were comparable for all baseline characteristics. Median OS was significantly higher in group A1 compared to B (26 vs. 6 months, P<0.001), as was median PFS (6 vs. 3 months, P=0.086).

Conclusions Early initiation of atezolizumab–bevacizumab after recurrence following curative therapy results in impressive survival rates, irrespective of recurrence pattern. Survival of atezolizumab–bevacizumab treated patients who were initially diagnosed in the BCLC-C stage is significantly different from those who recurred to BCLC-C following potentially curative therapies.

Keywords Hepatocellular carcinoma, recurrence, resection, ablation, atezolizumab–bevacizumab

Ann Gastroenterol 2024; 37 (6): 708-717