Changes in serum tumor marker levels are efficient predictors of complete response in patients with unresectable hepatocellular carcinoma treated with atezolizumab plus bevacizumab

Author:

Takeuchi Yasuto1ORCID,Sue Masahiko1,Adachi Takuya1,Onishi Hideki1,Takaki Akinobu1,Nouso Kazuhiro2,Kariyama Kazuya2,Kuwaki Kenji3,Toshimori Jyunichi4,Iwado Shota5,Moriya Akio6,Hagihara Hiroaki7,Takabatake Hiroyuki8,Tada Toshifumi9,Yasunaka Tetsuya10,Sakata Masahiro11,Otsuka Motoyuki1

Affiliation:

1. Okayama University Hospital: Okayama Daigaku Byoin

2. Okayama city hospital

3. Okayama Saiseikai General Hospital: Okayama Saiseikai Byoin

4. Japanese Red Cross Okayama Hospital: Okayama Sekijuji Byoin

5. Hiroshima Shiritsu Hiroshima Shimin Byoin

6. Mitoyo General Hospital: Mitoyo Sogo Byoin

7. Sumitomobesshi byoin

8. Kurashiki Central Hospital: Kurashiki Chuo Byoin

9. Himeji Red Cross Hospital: Himeji Sekijuji Byoin

10. Fukuyama City Hospital: Fukuyama Shimin Byoin

11. Fukuyama Iryo Center: Kokuritsu Byoin Kiko Fukuyama Iryo Center

Abstract

Abstract Background and aims: Atezolizumab plus bevacizumab therapy is recommended as first-line regimen for unresectable hepatocellular carcinoma (uHCC). Complete response (CR) is now being experienced at a consistent rate. This study aimed to identify predictive factors for CR.Methods A retrospective analysis of 319 patients with uHCC in whom atezolizumab plus bevacizumab therapy was introduced at our and joint research institutions from October 2020 to August 2023.Results Nineteen patients (6.0%) achieved CR. Multivariate analysis identified a Child–Pugh score 5 and decrease in alpha fetoprotein (AFP) levels of more than 20% at 3 weeks as significant and independent determinants of achieving CR. Sixteen of the 19 patients (84.2%) maintained a cancer-free status. Cancer-free patients had a significantly higher proportion of lower levels of Lens culinaris agglutinin-reactive AFP isoform (AFP-L3) at CR. Patients with AFL-L3 values of 15% or higher at CR had a significantly lower duration of response (log-rank test, P = 0.032).Conclusions Changes in AFP levels are important predictors of CR achievement in atezolizumab plus bevacizumab therapy. AFP-L3 levels are important for predicting maintenance of the therapeutic response.

Publisher

Research Square Platform LLC

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