Atezolizumab and bevacizumab in the treatment of advanced hepatocellular cancer with adverse factors and tumor thrombosis

Abstract

Introduction. Hepatocellular cancer in the Russian Federation remains an important problem due to the high one-year mortality rate, which is 61.9%. Рercentage of advanced stages of newly diagnosed patients – about 60%. We present the results combination therapy atezolizumab + bevacizumab in the first line in patients with HCC and unfavorable prognostic factors.Aim. To evaluate the efficacy of using the anti-VEGF/PD-L1 regimen of atezolizumab in combination with bevacizumab as first-line therapy in 23 patients with HCC and tumor thrombosis of the portal vein in real clinical practice.Materials and methods. The material of Blokhin National Medical Research Center of Oncology on the 23 patients with advanced HCC and tumor thrombosis of the portal vein, we receive the first line of therapy Atezolizumab 1200 mg + Bevacizumab 15 mg/kg 1 time in 21 days until progression or until intolerable toxicity. Efficiency was assessed according to RECIST 1.1 criteria. Analysis and statistical processing of the study results was carried out using the SPSS Statistics 23.0 program, based on the collected database. Survival analysis was performed using the Kaplan-Meier method. Descriptive statistics methods were used to analyze the socio-demographic and clinical characteristics of patients.Results. At median follow-up, one-year survival is estimated at 51.6%. Median progression-to-progression survival in the poor prognosis group was 13.2 months. The median overall survival was not reached. Efficacy of therapy: a partial response registered in 4 (17.5%), stabilization in 16 (65.5%), progression in 3 (13%). Grade 3 adverse events were detected in 6 (26%) patients. Cases of arterial hypertension of the 3 were observed in 2 patients (9%); bleeding from esophageal varices of the 3rd degree in 3 patients (13%); only 1 patient (4%) had autoimmune hepatitis, grade 3 diarrhea in one patient (4%).Conclusions. The use of atezolizumab + bevacizumab shows effective efficacy even in the group of patients with HCC complicated by thrombosis of the branches and trunk of the portal vein. Moreover, progression-free overall survival was better than in patients with distal portal vein thrombosis.