Impact of Prior Treatment History on Recurrence After Complete Response to Atezolizumab Plus Bevacizumab in Unresectable Hepatocellular Carcinoma

TL;DR

This study found that patients with unresectable liver cancer who had two or more prior treatments before atezolizumab plus bevacizumab were more likely to experience cancer recurrence after achieving a complete response.

Contribution

The study identifies prior treatment history as a novel independent predictor of recurrence after achieving complete response with atezolizumab plus bevacizumab in unresectable hepatocellular carcinoma.

Findings

A post-CR recurrence rate of 53.3% was observed in patients with unresectable HCC.

A history of ≥2 prior HCC treatments was independently associated with post-CR recurrence.

Predictive factors for treatment response did not correlate with post-CR recurrence.

Abstract

Integration of locoregional treatments (LRTs) with atezolizumab plus bevacizumab (atezo/bev) has improved treatment outcomes, enabling an increasing number of patients with unresectable hepatocellular carcinoma (HCC) to achieve a complete response (CR). A comprehensive analysis of recurrence following CR may provide insights into prognosis. This study aimed to identify the factors associated with post‐CR recurrence in unresectable HCC.

This retrospective study included 15 patients with unresectable HCC who achieved CR with atezo/bev therapy. The incidence and characteristics of post‐CR recurrence were analyzed.

Ten patients achieved CR by combining LRT with atezo/bev, whereas five achieved CR with atezo/bev alone. The post‐CR recurrence rate was 53.3% (recurrence group, n = 8; non‐recurrence group, n = 7). No significant differences were observed between the recurrence and non‐recurrence groups in HCC treatment history prior to atezo/bev initiation, predictive factors for treatment response, including the neutrophil‐to‐lymphocyte ratio, hepatic functional reserve, and tumor burden at the initiation of atezo/bev, treatment progress, or frequency of atezo/bev maintenance therapy post‐CR. In multivariate analysis, a history of ≥ 2 HCC treatments prior to atezo/bev initiation was independently associated with post‐CR recurrence (hazard ratio, 6.744; 95% confidence interval, 1.189–38.25; p = 0.031); conversely, predictive factors for atezo/bev response, treatment progress, and maintenance therapy did not contribute to post‐CR recurrence.

Given the high post‐CR recurrence rate with atezo/bev in unresectable HCC, vigilant surveillance remains essential even after achieving CR, particularly in patients with ≥ 2 prior HCC treatments before atezo/bev initiation.

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