Preliminary evidence of safety and tolerability of atezolizumab plus bevacizumab in patients with hepatocellular carcinoma and Child-Pugh A and B cirrhosis: a real-world study

Background & aims: Atezolizumab plus bevacizumab (AtezoBev) is the standard of care for first-line treatment of unresectable hepatocellular carcinoma (HCC). No evidence exists as to its use in routine clinical practice in patients with impaired liver function. Approach & results: In 216 HCC patients consecutively treated with AtezoBev across 11 tertiary centres we retrospectively evaluated treatment-related adverse events (trAEs) graded (G) according to CTCAE v5.0, including in the analysis all patients treated according to label (n=202, 94%). We also assessed overall survival (OS), progression-free survival (PFS), overall response (ORR) and disease control rates (DCR) defined by RECIST v1.1. Disease was mostly secondary to viral hepatitis, namely Hepatitis C (n=72; 36%) and Hepatitis B infection (n=35, 17%). Liver function was graded as Child-Pugh (CP)-A in 154 patients (76%) and CP-B in 48 (24%). Any grade trAEs were reported by 143 patients (71%), of which 53 (26%) were G3 and 3 (2%) G4. Compared to CP-A, CP-B patients showed comparable rates of trAEs. Presence and grade of varices at pre-treatment esophagogastroduodenoscopy did not correlate with bleeding events. After a median follow-up of 9.0 months (95%CI, 7.8-10.1), median OS was 14.9 months (95%CI, 13.6-16.3), while median PFS was 6.8 months (95%CI, 5.2-8.5). ORR and DCR were respectively 25% and 73%, with no difference across CP classes. Conclusions: This study confirms reproducible safety and efficacy of AtezoBev in routine practice. CP-B patients reported similar tolerability compared to CP-A, warranting prospective evaluation of AtezoBev in this treatment-deprived population.