The prediction of early progressive disease in patients with hepatocellular carcinoma receiving atezolizumab plus bevacizumab

BACKGROUND AND AIMS: The IMbrave 150 trial revealed the usefulness of atezolizumab plus bevacizumab therapy in patients with unresectable hepatocellular carcinoma (HCC), making it now considered the first‐line systemic chemotherapy agent for HCC. The present study investigated factors associated with early tumor progression of atezolizumab plus bevacizumab in patients with advanced HCC in real‐world clinical practice. METHODS: A total of 184 HCC patients who received atezolizumab plus bevacizumab therapy were studied. We investigated the frequency of early progressive disease (e‐PD; PD within 9 weeks) and analyzed the risk factors for e‐PD. RESULTS: There were 47 patients (25.5%) diagnosed as e‐PD. Patients with e‐PD had a worse performance status (PS) and albumin–bilirubin (ALBI) and Child‐Pugh (C‐P) scores and a significantly higher rate of a systemic therapy than those with non‐e‐PD. A multivariate analysis showed that PS ≥1 (odds ratio [OR] = 4.5, 95% confidence interval [CI] = 1.9–10, p < 0.001), ALBI score ≥−2.30 (OR = 2.1, 95% CI = 1.0–4.5, p = 0.044) and the history of a systemic therapy (OR = 3.0, 95% CI = 1.4–6.4, p = 0.0038) were significant and independent determinants of e‐PD. When examining the liver function trends in e‐PD patients, the ALBI scores at 3 and 6 weeks after starting therapy were significantly higher than before the treatment (p < 0.001). CONCLUSIONS: The liver function and systemic therapy are useful predictors of e‐PD in HCC patients treated with atezolizumab plus bevacizumab in real‐world clinical practice.