Impact of renal function on the prognosis of patients receiving Atezolizumab/Bevacizumab combination therapy and Lenvatinib monotherapy for unresectable hepatocellular carcinoma

Introduction: Several studies have reported kidney injury caused by immune checkpoint inhibitors, and proteinuria caused by vascular endothelial growth factor inhibitors for unresectable hepatocellular carcinoma (u-HCC). We investigated the relationship between renal function and prognosis in patients with u-HCC receiving Atezolizumab and Bevacizumab (AB) and Lenvatinib (LEN) therapy.Methods: Fifty-one patients who received AB, and 50 patients who received LEN therapy were included. We analyzed prognostic factors related to the overall survival (OS), and characteristics related to renal function.Results: In patients with AB therapy, OS was shorter in patients with baseline proteinuria of 1+ or higher, as assessed by urine dipstick test, compared to those with -/+/- (p=0.024). There were many cases with two or more drugs with a high risk of renal dysfunction (p = 0.019) in patients with 1+ or higher. Furthermore, OS was shorter in the group with estimated glomerular filtration rate (eGFR) grade deterioration without urinary protein-creatinine ratio (UPCR) of 2g/g center dot Cre or higher than in the other groups (p=0.027). In the group where eGFR worsened without an increase in UPCR, there were many cases with a daily salt intake of 10 g or more (p=0.027), three or more drugs with a high risk of renal dysfunction (p=0.021), and a history of arteriosclerosis (p=0.021). On the other hand, in patients with LEN therapy, OS tend to be shorter in patients with proteinuria of +/- or higher, compared to those without (p=0.074). There were many cases with a daily salt intake of 10 g or more in patients with +/- or higher (p=0.002).Conclusion: In patients receiving AB and LEN therapy, baseline proteinuria was associated with OS. Renal function deterioration without proteinuria was associated with a poor prognosis in AB therapy. Excessive salt intake, pre-existing atherosclerotic disease, and drug with a high risk of renal dysfunction were risk factors for renal deterioration.