Efficacy and safety of atezolizumab plus bevacizumab in Korean patients with advanced hepatocellular carcinoma

Abstract Background & Aims Atezolizumab plus bevacizumab (Ate/Bev) has demonstrated efficacy and safety in patients with advanced hepatocellular carcinoma (HCC) in the phase III trial. Further evaluation is necessary to investigate the safety and efficacy of Ate/Bev in real settings. Methods This was a multicentre retrospective analysis. Between May 2020 and February 2021, 138 patients received Ate/Bev as first‐line treatment for advanced HCC from 11 institutions. We excluded patients with Child‐Pugh B or C and BCLC D stage, and the remaining 121 patients were included in this analysis. Results According to RECIST 1.1, the objective response and disease control rates were 24.0% and 76.0%. The median follow‐up duration was 5.9 months (95% confidence interval [CI], 5.4‐6.4), the median progression‐free survival (PFS) was 6.5 months (95% CI, 4.1‐9.0), and median overall survival (OS) was not reached (95% CI, not available). The most frequent grade 3‐4 adverse event was aspartate aminotransferase elevation (10.7%). In the multivariate analyses, AFP increase ( P = .037), baseline neutrophil‐to‐lymphocyte ratio (NLR) ≥ 5 ( P = .023), and best response to stable disease or progressive disease ( P = .019) were significantly associated with worse PFS. Macrovascular invasion ( P = .048) and baseline NLR ≥5 ( P < .001) were significantly associated with worse OS. Conclusions Ate/Bev showed real‐life efficacy and safety in Korean patients with advanced HCC, in line with results from phase III trial. Considering unfavourable survival outcomes of Ate/Bev in patients with elevated NLR, careful assessment of treatment response needs to be performed in this group.