The Effectiveness of Long-Term Continuation of Atezolizumab plus Bevacizumab in Patients Receiving Systemic Chemotherapy for Advanced Hepatocellular Carcinoma: A Multicenter Study

Changes in liver function in patients with unresectable hepatocellular carcinoma (u-HCC), following extended periods from the initiation of atezolizumab plus bevacizumab (Atez/Bev), have not been fully investigated. Of 148 u-HCC patients treated with first-line Atez/Bev, the study enrolled 38 u-HCC patients treated with first-line Atez/Bev, whose treatment response was initially evaluated as non-progressive disease (non-PD) and later as PD on imaging, and who then received second-line systemic chemotherapy. We evaluated the relationship between the period from the initiation of first-line Atez/Bev to that of second-line systemic chemotherapy with liver function and prognosis. According to the periods from the initiation of Atez/Bev to that of the second-line therapy, patients were classified into a long continuation group (Group-L, n = 19), ≥11 months; or a short continuation group (Group-S, n = 19), <11 months. The albumin-bilirubin (ALBI) score at the initiation of the second-line therapy did not differ significantly between the groups (median: -2.38 vs. -2.02, p = 0.559), and the change in ALBI score also did not differ significantly between the groups (median: 0.42 vs. 0.51, p = 0.770). Group-L had significantly better overall survival (OS) than Group-S (not reached vs. 18 months, p = 0.008). Liver function did not decrease even after long-term treatment with first-line Atez/Bev in patients who were able to progress to second-line therapy, indicating that long continuation of first-line Atez/Bev may be valuable for improving OS.