Clinical efficacy of Atezolizumab/Bevacizumab combined with TACE in treating BCLC stage C hepatocellular carcinoma

TL;DR

Combining Atezolizumab/Bevacizumab with TACE may improve outcomes for advanced liver cancer patients, with safety and potential biomarkers identified.

Contribution

Demonstrates the safety and potential efficacy of triple therapy for BCLC stage C HCC and identifies NLR as a possible biomarker.

Findings

Objective response rate was 32% with a PFS of 7.96 months and OS of 12.88 months.

Patients with NLR ≥ 3 had significantly worse PFS and OS compared to those with NLR < 3.

All patients experienced adverse reactions, but no treatment-related deaths occurred.

Abstract

The prognosis of advanced primary liver cancer [Barcelona Clinic Liver Cancer (BCLC) stage C] remains poor. Although atezolizumab plus bevacizumab (Ate/Bev) is a standard treatment, the potential of intensifying this regimen into a triple therapy by adding local intervention is unclear.

To evaluate the efficacy of Ate/Bev plus transarterial chemoembolisation (TACE) in the treatment of BCLC stage C advanced hepatocellular carcinoma (HCC).

The clinical data of 25 patients with BCLC-C HCC treated with Ate/Bev plus TACE at Guangdong Provincial Traditional Chinese Medicine Hospital between January 2022 and October 2024 were retrospectively analyzed. Efficacy was evaluated using Response Evaluation Criteria in Solid Tumors version 1.1, with follow-up until April 2025. The primary endpoints included the objective response rate, disease control rate, progression-free survival (PFS), and safety.

Of the 33 patients with intermediate-/advanced-stage HCC receiving the triple therapy, 25 were categorized as BCLC stage C HCC. Twelve patients died, and thirteen survived, during follow-up. The objective response rate was 32%, PFS was 7.960 ± 6.624 months, and overall survival (OS) was 12.880 ± 7.769 months. OS and PFS significantly differed by the neutrophil-to-lymphocyte ratio (≥ 3 vs < 3). The hazard ratios for median PFS and median OS were significantly different (P < 0.005) between the two groups, at 2.004 (95% confidence interval: 1.86–3.74) and 1.765 (95% confidence interval: 1.24–3.06), respectively. The incidence of all-grade adverse reactions was 100%, with grade 3/4 events seen in 4% of patients. No treatment-related deaths occurred.

Atezolizumab combined with bevacizumab and TACE may be safe and effective in the treatment of BCLC stage C hepatocellular carcinoma. Baseline NLR may be an important potential biomarker for predicting the efficacy and prognosis of such patients. However, the above conclusions still need to be further verified by large-sample prospective randomized controlled trials.

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