Atezolizumab and Bevacizumab in Patients with Advanced Hepatocellular Carcinoma with Impaired Liver Function and Prior Systemic Therapy: a Real-world Experience

Objective: Evaluation of the efficacy and safety of atezolizumab/bevacizumab in a real-world HCC cohort, including patients with impaired liver function and prior systemic therapy.

Methods: Retrospective analysis of 147 HCC patients treated with atezolizumab/bevacizumab at six sites in Germany and Austria.

Results: The overall response rate and disease control rate were 20.4% and 51.7%, respectively. Seventy-three patients (49.7%) met at least one major exclusion criterion of the IMbrave150 trial (IMbrave-OUT), whereas 74 patients (50.3%) were eligible (IMbrave-IN). Median overall survival (mOS) as well as median progression-free survival (mPFS) was significantly longer in IMbrave-IN IMbrave-OUT patients [mOS: 15.0 months (95% confidence interval (CI): 10.7-19.3] 6.0 months (95% CI: 3.2-8.9;  < 0.001) and mPFS: 8.7 months (95% CI: 5.9-11.5) 3.7 months (95% CI: 2.7-4.7;  < 0.001)]. Prior systemic treatment did not significantly affect mOS [hazard ratio (HR): 1.32 (95% CI: 0.78-2.23;  = 0.305)]. mOS according to ALBI grades 1/2/3 were 15.0 months (95% CI: not estimable), 8.6 months (95% CI: 5.4-11.7), and 3.2 months (95% CI: 0.3-6.1), respectively. ALBI grade and ECOG score were identified as independent prognostic factors [ALBI grade 2 1; HR: 2.40 (95% CI: 1.34 - 4.30;  = 0.003), ALBI grade 3 1; HR: 7.28 (95% CI: 3.30-16.08;  < 0.001), and ECOG ⩾2 0; HR: 2.09 (95% CI: 1.03 - 4.23;  = 0.042)], respectively. Sixty-seven patients (45.6%) experienced an adverse event classified as CTCAE grade ⩾3. Patients in the IMbrave-OUT group were at increased risk of hepatic decompensation with encephalopathy (13.7% 1.4%,  = 0.004) and/or ascites (39.7% 9.5%;  < 0.001).

Conclusion: In this real-world cohort, efficacy was comparable to the results of the IMbrave150 study and not affected by prior systemic treatment. ALBI grade and ECOG score were independently associated with survival. IMbrave-OUT patients were more likely to experience hepatic decompensation.