Outcome of Atezolizumab Plus Bevacizumab Combination Therapy in High-Risk Patients with Advanced Hepatocellular Carcinoma

Simple Summary Although ATE + BEV treatment provides improved therapeutic efficacy, in our study, high-risk populations such as patients with grade Vp4 portal vein thrombus, bile duct invasion, or more than 50% liver infiltration had poor responses. This study aimed to investigate real-world outcomes and prognostic factors in high-risk patients with advanced HCC treated with atezolizumab plus bevacizumab. Unlike what was reported in the IMbrave150 study, atezolizumab plus bevacizumab treatment had consistent efficacy and tolerability in both the total and high-risk population in our study. Radiation therapy combined with atezolizumab plus bevacizumab treatment might be helpful to improve progression-free survival and overall survival in high-risk groups.Abstract Real-world data regarding treatment with atezolizumab plus bevacizumab in high-risk patients with advanced HCC are lacking. In this multicenter retrospective cohort study, a total of 215 patients with advanced HCC received atezolizumab plus bevacizumab treatment at four tertiary hospitals. High-risk patients were those with grade Vp4 portal vein thrombus, bile duct invasion, or more than 50% liver infiltration. In total, 98 (45.6%) were the high-risk population, 186 (86.5%) were considered to be Child-Pugh class A, and 128 (59.5%) had previously received neoadjuvant or concomitant radiation treatment. Median overall survival (OS) was 11.25 months (95% CI, 9.50-13.10), and the median progression-free survival (PFS) was 8.00 months (95% CI, 6.82-9.18). In the high-risk population, the median OS was 10 months (95% CI, 8.19-11.82) and the median PFS was 6.50 months (95% CI, 3.93-9.08). In the high-risk population, multivariate analysis indicated that radiation therapy and lower ALBI grade were associated with better OS and PFS. A total of 177 (82.3%) patients experienced adverse events of any grade, the most common being proteinuria (23.7%). Atezolizumab plus bevacizumab treatment showed consistent efficacy and tolerability in both the total and high-risk population. Radiation therapy combined with atezolizumab plus bevacizumab treatment might be helpful to improve PFS and OS in high-risk populations.