Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2022

Atezolizumab and bevacizumab for advanced hepatocellular carcinoma: a single centre real world experience (#237)

Pei Ying Tan 1 , Samuel Hui 1 2 , Paul O'Neill 2 , Anouk Dev 1 2
  1. School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
  2. Department of Gastroenterology and Hepatology, Monash Health, Clayton, Victoria, Australia

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Background

Atezolizumab, a programmed-death-ligand-1 inhibitor and Bevacizumab, a vascular-endothelial-growth-factor inhibitor in combination (A+B), is now the standard first-line treatment for advanced hepatocellular carcinoma (HCC). The registration trial conducted internationally reported a median overall-survival (OS) of 10.8-months and a progression-free-survival (PFS) of 7.0-months. We aimed to document OS and PFS in an Australian population.

Methods

We conducted an observational study of patients with advanced HCC treated with combination A+B from November 2020 to August 2022 at a single tertiary centre. Primary outcomes were OS and PFS.  Treatment related adverse-events (AEs) including immune-related adverse-events (irAEs) were secondary outcomes.

Results

25 patients were included (mean age 65±14 years, males 88%). The median time on treatment was 10-months with the longest duration of 18-months. Treatment discontinuation resulted from progressive disease (n=4), death (=2), and irAE (n=2). The mean Child-Pugh Score was A5. 8% (n=2) of patients were early-stage Barcelona Clinic Liver Cancer (BCLC) A, 36% (n=9) were intermediate-stage (BCLC-B) and 56% (n=14) were advanced-stage (BCLC-C). 84% underwent baseline endoscopic variceal assessment, of whom 40% had varices.

At a median follow-up of 10-months, median OS was 10-months and PFS was 7-months. IrAEs occurred in 36% including rash (16%), thyroiditis (8%), hypophysitis (4%), thrombocytopenia (4%) and colitis (4%). Additionally, 8% experienced new-onset subclinical hypothyroidism. 28% experienced proteinuria and 84% experienced hypertension.

Conclusion

Patients in our real world cohort demonstrated commensurate outcomes to the registration studies. About a third of patients experienced irAEs, with 8% resulting in treatment discontinuation. Hypertension and proteinuria were common side effects. Longer term follow up is needed to confirm ongoing benefit.