Efficacy and Safety of Atezolizumab and Bevacizumab in the Real-World Treatment of Advanced Hepatocellular Carcinoma: Experience from Four Tertiary Centers

SIMPLE SUMMARY: Hepatocellular carcinoma is one of the most common cancers in the world with increasing incidence. In advanced stages, according to the Barcelona Clinic Liver Cancer (BCLC) staging defined by number, size, vessel infiltration status, and patient’s performance status, the therapy of choice is systemic therapy. For several years, the tyrosine kinase inhibitor sorafenib was the only therapeutic option. Atezolizumab and bevacizumab are administered as a combination therapy promoting PD-L1 inhibition and anti-VEGF activity, which yields synergistic effects against cancer. The IMBRAVE150 trial investigated the use of this combination therapy versus that of sorafenib and showed an increase in overall patient survival to nearly 20 months. In this work, we investigated the real-world efficacy and safety of this combination in different centers. ABSTRACT: The combination of atezolizumab and bevacizumab (A + B) is the new standard of care for the systemic first-line treatment of hepatocellular carcinoma (HCC). However, up to now there are only few data on the safety and efficacy of A + B in real life. We included patients with advanced HCC treated with A + B as first-line therapy at four cancer centers in Germany and Austria between December 2018 and August 2021. Demographics, overall survival (OS), and adverse events were assessed until 15 September 2021. We included 66 patients. Most patients had compensated cirrhosis (n = 34; 52%), while Child–Pugh class B cirrhosis was observed in 23 patients (35%), and class C cirrhosis in 5 patients (8%). The best responses included a complete response (CR) in 7 patients (11%), a partial response (PR) in 12 patients (18%), stable disease (SD) in 22 patients (33%), and progressive disease in 11 patients (17%). The median progression-free (PFS) survival was 6.5 months, while the median overall survival (OS) was not reached in this cohort (6-month OS: 69%, 12-month OS: 60%, 18-month OS: 58%). Patients with viral hepatitis seemed to have a better prognosis than patients with HCC of non-viral etiology. The real-world PFS and OS were comparable to those of the pivotal IMBRAVE trial, despite including patients with worse liver function in this study. We conclude that A + B is also highly effective in a real-life setting, with manageable toxicity, especially in patients with compensated liver disease. In patients with compromised liver function (Child B and C), the treatment showed low efficacy and, therefore, it should be well considered before administration to these patients.