Combination of atezolizumab and bevacizumab in patients with inoperable hepatocellular cancer in real clinical practice

Introduction. In the structure of Russian cancer incidence, malignant neoplasms (MN) of the liver occupy 1.61%. Patients with initially unresectable hepatocellular cancer (HCC) or progressive HCC after local treatment methods, in the absence of contraindications, are subject to systemic therapy.

Aim. To evaluate the direct effectiveness and long-term results of treatment of patients with inoperable HCC with the combination of atezolizumab and bevacizumab in real clinical practice.

Materials and methods. A multicenter (7 centers) retrospective observational study was conducted. It includes 56 previously untreated patients and 12 pretreated patients with a confirmed diagnosis of HCC who were treated with atezolizumab and bevacizumab. The male to female ratio was 2:1, with an average age of 60 years. ECOG 0-1 was in 86.8%, Child-Pugh liver function A – in 76.5%, B – in 23.5%, macroscopic portal vein invasion – in 27.9%, extrahepatic spread – in 35.3%, AFP more than 400 IU/ml – in 38.2%.

Results. Use of the atezolizumab and bevacizumab regimen as a first line led to a partial response in 7 patients (12.5%), to stabilization in 39 (69.6%), to progression in 10 (17.9%). The disease control rate was 82.1%, median progression free survival (PFS) was 9.9 months (95% confidence interval (CI) 6.2-n/a). Median overall survival (OS) was not reached (95% CI 10.2-n/a). PFS was significantly influenced by the functional state of the liver according to the Child-Pugh scale. Median PFS in class A was 18.0 months, in class B – 5.6 months: HR 2.54; 95% CI 0.92–7.05; p = 0.03.

Conclusion. The atezolizumab and bevacizumab regimen in real clinical practice demonstrates tolerability of therapy and treatment results that are not inferior to the data obtained in the registration study. No new adverse events were identified.

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