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Real-World Outcomes of Atezolizumab With Bevacizumab Treatment in Hepatocellular Carcinoma Patients: Effectiveness, Esophagogastroduodenoscopy Utilization and Bleeding Complications
Lee, C.-L.; Freeman, M.; Burak, K.W.; Moffat, G.T.; O’Donnell, C.; Ding, P.Q.; Lyubetska, H.; Meyers, B.M.; Gordon, V.; Kosyachkova, E.; Bucur, R.; Cheung, W.Y.; Knox, J.J.; Tam, V.C. Real-World Outcomes of Atezolizumab with Bevacizumab Treatment in Hepatocellular Carcinoma Patients: Effectiveness, Esophagogastroduodenoscopy Utilization and Bleeding Complications. Cancers2024, 16, 2878.
Lee, C.-L.; Freeman, M.; Burak, K.W.; Moffat, G.T.; O’Donnell, C.; Ding, P.Q.; Lyubetska, H.; Meyers, B.M.; Gordon, V.; Kosyachkova, E.; Bucur, R.; Cheung, W.Y.; Knox, J.J.; Tam, V.C. Real-World Outcomes of Atezolizumab with Bevacizumab Treatment in Hepatocellular Carcinoma Patients: Effectiveness, Esophagogastroduodenoscopy Utilization and Bleeding Complications. Cancers 2024, 16, 2878.
Lee, C.-L.; Freeman, M.; Burak, K.W.; Moffat, G.T.; O’Donnell, C.; Ding, P.Q.; Lyubetska, H.; Meyers, B.M.; Gordon, V.; Kosyachkova, E.; Bucur, R.; Cheung, W.Y.; Knox, J.J.; Tam, V.C. Real-World Outcomes of Atezolizumab with Bevacizumab Treatment in Hepatocellular Carcinoma Patients: Effectiveness, Esophagogastroduodenoscopy Utilization and Bleeding Complications. Cancers2024, 16, 2878.
Lee, C.-L.; Freeman, M.; Burak, K.W.; Moffat, G.T.; O’Donnell, C.; Ding, P.Q.; Lyubetska, H.; Meyers, B.M.; Gordon, V.; Kosyachkova, E.; Bucur, R.; Cheung, W.Y.; Knox, J.J.; Tam, V.C. Real-World Outcomes of Atezolizumab with Bevacizumab Treatment in Hepatocellular Carcinoma Patients: Effectiveness, Esophagogastroduodenoscopy Utilization and Bleeding Complications. Cancers 2024, 16, 2878.
Abstract
The IMbrave150 trial established atezolizumab with bevacizumab (A+B) as standard care for hepatocellular carcinoma (HCC), recommending an esophagogastroduodenoscopy (EGD) within 6 months of treatment initiation to prevent bleeding from esophagogastric varices. The necessity of mandatory EGD for all patients remains unclear. We retrospectively analyzed 112 HCC patients treated with A+B at five Canadian cancer centers from July 1, 2020, to August 31, 2022. A+B was the first-line therapy for 90% of patients, with median overall survival at 20.3 months and progression-free survival at 9.6 months. There was no survival difference between patients with bleeding and those without. Before A+B, 71%(79) of patients underwent an EGD within 6 months, revealing varices in 41%(32) and requiring intervention in 19%(15). The overall bleeding rate was 15%(17), with GI-specific bleeding occurring in 83%(5) of the EGD group and 17%(1) of the non-EGD group (p=0.24). Non-GI bleeding was observed in 10%(11) of patients. Outcomes for HCC patients treated with A+B in Canada were comparable to IMbrave150. Our study showed twice the rate of varices detection and treatment compared to IMbrave150, reflecting real-world treatment of high-risk populations. There was no increased GI bleeding in patients without pre-treatment EGD, supporting a selective EGD approach.
Keywords
atezolizumab; bevacizumab; hepatocellular carcinoma; EGD; varices; GI bleeding
Subject
Medicine and Pharmacology, Gastroenterology and Hepatology
Copyright:
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.