Background: Atezolizumab plus bevacizumab (atezo+bev) is a standard-of-care 1L treatment for unresectable hepatocellular carcinoma (uHCC). Understanding its adoption and use, clinical outcomes, and subsequent therapies are needed.
Methods: This retrospective cohort study included 550 patients with uHCC in the US who initiated 1L atezo+bev between June 2020 and April 2023. Medical records were abstracted to describe treatment patterns and outcomes.
Results: Of 294 patients who discontinued 1L therapy, 176 patients initiated 2L therapy (2L cohort) and 48 patients didn't initiate 2L therapy after ≥8 weeks of follow-up (No 2L cohort). More of the No 2L cohort had Stage IVb tumors, BCLC stage D, ECOG-PS ≥2, ascites, and hepatic encephalopathy at baseline. The 2L cohort were more likely to discontinue atezo+bev due to disease progression (92.1% vs. 56.3%), and less likely due to toxicity/intolerability (4.0% vs. 10.4%) than the No 2L cohort. OS from 1L atezo+bev initiation was significantly longer in the 2L cohort vs. No 2L cohort (median 23.0 vs. 14.3 months; p < 0.001]).
Conclusions: 1L Atezo+bev was clinically active with 256 patients remaining on therapy at last follow-up. Patients who progressed after 1L atezo+bev benefited from additional systemic therapies. Future research analyzing the comparative effectiveness of 2L therapies is needed.
Keywords: Atezolizumab; bevacizumab; cancer immunotherapy; hepatocellular carcinoma; real-world effectiveness.
This study looked at people in the United States with a type of liver cancer called hepatocellular carcinoma (HCC) who were treated with a combination of two medicines, atezolizumab and bevacizumab, as their first treatment. The researchers wanted to understand what happens to patients after this initial treatment, especially if and why they go on to receive a second round of treatment or not. Out of 550 patients, after stopping the first treatment, some started a second treatment, while others did not. The study found that patients who went on to get a second treatment tended to have less severe illnesses and were in better health at the start of the first treatment and they lived longer on average than those who did not get a second treatment. It was also reported that the patients who started a second treatment most often stopped their first treatment because their cancer got worse while in contrast, those who did not start a second treatment were more likely to stop the first treatment because of side effects or their own choice. Additionally, the study counted how many people had liver problems like hepatitis, alcohol-related liver disease, or fatty liver disease at the start of the first treatment. This information gives important background about the initial state of health of the patients in the study. The results of this study highlight the importance of choosing the right treatment early and switching to new therapies when needed. Understanding these patterns can help doctors make better decisions and improve care for people with liver cancer.