Therapeutic Modifications without Discontinuation of Atezolizumab Plus Bevacizumab Therapy Are Associated with Favorable Overall Survival and Time to Progression in Patients with Unresectable Hepatocellular Carcinoma

Takayuki Tokunaga; Masakuni Tateyama; Yasuteru Kondo; Satoshi Miuma; Shiho Miyase; Kentaro Tanaka; Satoshi Narahara; Hiroki Inada; Sotaro Kurano; Yoko Yoshimaru; Katsuya Nagaoka; Takehisa Watanabe; Hiroko Setoyama; Kotaro Fukubayashi; Motohiko Tanaka; Yasuhito Tanaka

doi:10.3390/cancers15051568

Cancers (Mar 2023)

Therapeutic Modifications without Discontinuation of Atezolizumab Plus Bevacizumab Therapy Are Associated with Favorable Overall Survival and Time to Progression in Patients with Unresectable Hepatocellular Carcinoma

Takayuki Tokunaga,
Masakuni Tateyama,
Yasuteru Kondo,
Satoshi Miuma,
Shiho Miyase,
Kentaro Tanaka,
Satoshi Narahara,
Hiroki Inada,
Sotaro Kurano,
Yoko Yoshimaru,
Katsuya Nagaoka,
Takehisa Watanabe,
Hiroko Setoyama,
Kotaro Fukubayashi,
Motohiko Tanaka,
Yasuhito Tanaka

Affiliations

Takayuki Tokunaga: Department of Gastroenterology and Hepatology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto City 860-8556, Kumamoto, Japan
Masakuni Tateyama: Department of Gastroenterology and Hepatology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto City 860-8556, Kumamoto, Japan
Yasuteru Kondo: Sendai Kousei Hospital, 4-15 Sakamoto, Aoba-ku, Sendai City 980-0873, Miyagi, Japan
Satoshi Miuma: Department of Gastroenterology and Hepatology, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki City 852-8501, Nagasaki, Japan
Shiho Miyase: Kumamoto Shinto General Hospital, 3-2-65 Ooe, Chuo-ku, Kumamoto City 862-8655, Kumamoto, Japan
Kentaro Tanaka: Department of Gastroenterology and Hepatology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto City 860-8556, Kumamoto, Japan
Satoshi Narahara: Department of Gastroenterology and Hepatology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto City 860-8556, Kumamoto, Japan
Hiroki Inada: Department of Gastroenterology and Hepatology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto City 860-8556, Kumamoto, Japan
Sotaro Kurano: Department of Gastroenterology and Hepatology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto City 860-8556, Kumamoto, Japan
Yoko Yoshimaru: Department of Gastroenterology and Hepatology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto City 860-8556, Kumamoto, Japan
Katsuya Nagaoka: Department of Gastroenterology and Hepatology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto City 860-8556, Kumamoto, Japan
Takehisa Watanabe: Department of Gastroenterology and Hepatology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto City 860-8556, Kumamoto, Japan
Hiroko Setoyama: Department of Gastroenterology and Hepatology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto City 860-8556, Kumamoto, Japan
Kotaro Fukubayashi: Kumamoto Kenhoku Hospital, 550 Tamana, Tamana City 860-0005, Kumamoto, Japan
Motohiko Tanaka: Public Health and Welfare Bureau, City of Kumamoto, 1-1 Tetori-honcho, Chuo-ku, Kumamoto City 860-8601, Kumamoto, Japan
Yasuhito Tanaka: Department of Gastroenterology and Hepatology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto City 860-8556, Kumamoto, Japan

DOI: https://doi.org/10.3390/cancers15051568
Journal volume & issue: Vol. 15, no. 5
p. 1568

Abstract

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We retrospectively evaluated the impact of therapeutic modifications of atezolizumab (Atezo) plus bevacizumab (Bev) therapy (Atezo/Bev), including the interruption or discontinuation of both Atezo and Bev, and the reduction or discontinuation of Bev, on the outcome of patients with unresectable hepatocellular carcinoma (uHCC) (median observation period: 9.40 months). One hundred uHCC from five hospitals were included. Therapeutic modifications without discontinuation of both Atezo and Bev (n = 46) were associated with favorable overall survival (median not reached; hazard ratio (HR): 0.23) and time to progression (median: 10.00 months; HR: 0.23) with no therapeutic modification defined as the reference. In contrast, the discontinuation of both Atezo and Bev without other therapeutic modifications (n = 20) was associated with unfavorable overall survival (median: 9.63 months; HR: 2.72) and time to progression (median: 2.53 months; HR: 2.78). Patients with modified albumin–bilirubin grade 2b liver function (n = 43) or immune-related adverse events (irAEs) (n = 31) discontinued both Atezo and Bev without other therapeutic modifications more frequently (30.2% and 35.5%, respectively) than those with modified albumin–bilirubin grade 1 (10.2%) and without irAEs (13.0%). Patients with objective response (n = 48) experienced irAEs more frequently (n = 21) than those without (n = 10) (p = 0.027). Avoiding the discontinuation of both Atezo and Bev without other therapeutic modifications may be the optimal management of uHCC.

Published in Cancers

ISSN: 2072-6694 (Online)
Publisher: MDPI AG
Country of publisher: Switzerland
LCC subjects: Medicine: Internal medicine: Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Website: https://www.mdpi.com/journal/cancers/

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