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Modest activity of atezolizumab plus bevacizumab in Child-Pugh B HCC

Presented by
Dr Hyeyeong Kim, Ulsan University Hospital, South Korea
ASCO GI 2022
Phase 3, IMbrave150
The combination of atezolizumab plus bevacizumab demonstrated modest clinical activity in patients with Child-Pugh B advanced hepatocellular carcinoma (HCC) in the phase 3 IMbrave150 trial. However, the frequency of serious adverse events (AEs) was relatively high. Further studies are needed to carefully select the patients who may benefit from this combination regimen [1].

“The phase 3 IMbrave150 trial (NCT03434379) showed encouraging efficacy and safety of atezolizumab plus bevacizumab as first-line therapy in patients with advanced HCC,” said Dr Hyeyeong Kim (Ulsan University Hospital, South Korea). “However, this trial did not include patients with Child-Pugh B HCC. Therefore, a retrospective study was performed to assess 37 Child-Pugh B classified patients with advanced HCC who underwent atezolizumab plus bevacizumab therapy in the first-line.” The data was compared with a cohort of Child-Pugh A patients from the same registry (n=139).

After atezolizumab plus bevacizumab therapy, the objective response rate (ORR) was 10.8% in Child-Pugh B classified patients, with all responses being partial. In addition, 45.9% of the patients demonstrated stable disease. In the Child-Pugh A cohort the ORR was 33.8%, with 1 complete response. Also, 42.4% of the patients in this cohort had stable disease. The median progression-free survival was 2.9 months in the Child-Pugh B group and 9.6 months in the Child-Pugh A group (P<0.001). The median overall survival (OS) was longer in the Child-Pugh A cohort (not-reached vs 6.0 months; P<0.001). Notably, patients with Child-Pugh B7 classification had a longer median OS time than Child-Pugh B8–9 classified patients (6.4 vs 3.6 months; P=0.016).

The safety analysis showed that grade 3 or 4 AEs were more common in the Child-Pugh B cohort than in the Child-Pugh A cohort (43.2% vs 18.0%). In addition, grade 3 or 4 gastrointestinal haemorrhage (10.8% vs 0.7%; P=0.001), neutropenia (10.8% vs 0%; P<0.001), and thrombocytopenia (10.8% vs 0.7%; P=0.001) occurred significantly more frequently in the Child-Pugh B cohort. Also, the rate of treatment discontinuations due to AEs was higher in the Child-Pugh B group (16.2% vs 5.8%; P=0.047).

  1. Kim H, et al. Atezolizumab plus bevacizumab in Child-Pugh B advanced hepatocellular carcinoma patients. Abstract 397, ASCO GI 2022, 20–22 January.


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