Abstract
Purpose
Hepatocellular carcinoma (HCC) is a common and deadly form of liver cancer. Combination atezolizumab and bevacizumab has improved the outcomes for patients with advanced disease. We sought to determine the impact of etiology on outcomes of patients treated with atezolizumab and bevacizumab.
Methods
This study used a real-world database. The primary outcome was overall survival (OS) by etiology of HCC; the secondary outcome was real-world time to treatment discontinuation (rwTTD). Time-to-event analyses was performed by the Kaplan–Meier method; the log-rank test to assess for differences by etiology from date of first receipt of atezolizumab and bevacizumab. The Cox proportional hazards model was used to calculate hazard ratios.
Results
In total, 429 patients were included (n = 216 Viral-HCC; n = 68 Alcohol-HCC; n = 145, NASH-HCC). The median overall survival for the entire cohort was 9.4 months (95% CI 7.1–10.9). Compared with Viral-HCC, the hazard ratio (HR) of death was 1.11 (95% CI 0.74–1.68, p = 0.62) for Alcohol-HCC and was 1.34 (95% CI 0.96–1.86, p = 0.08) for NASH-HCC. The median rwTTD for the entire cohort was 5.7 months (95% CI 5.0–7.0 months). The HR of rwTTD was 1.24 (95% CI 0.86–1.77, p = 0.25) for Alcohol-HCC and was 1.31 (95% CI 0.98–1.75, p = 0.06) in reference to TTD with Viral-HCC.
Conclusions
In this real-world cohort of patients with HCC receiving first-line atezolizumab and bevacizumab, we did not identify an association between etiology and OS or rwTTD. This suggests that the efficacy of atezolizumab and bevacizumab may be similar across HCC etiologies. Further prospective studies are needed to confirm these findings.
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Data availability
The data that support the findings of this study have been originated by Flatiron Health, Inc. These de-identified data may be made available upon request and are subject to a license agreement with Flatiron Health; interested researchers should contact DataAccess@flatiron.com to determine licensing terms.
Abbreviations
- AFP:
-
Alpha-fetoprotein
- AIC:
-
Akaike’s information criterion
- ALT:
-
Alanine aminotransferase
- AST:
-
Aspartate aminotransferase
- BIC:
-
Bayesian information criterion
- CI:
-
Confidence interval
- ECOG:
-
Eastern Cooperative Oncology Group
- EHR:
-
Electronic health record
- HCC:
-
Hepatocellular carcinoma
- HR:
-
Hazard ratio
- ICD:
-
International classifications of disease
- INR:
-
International Normalized Ratio
- LOINC:
-
Logical Observation Identifiers Names and Codes
- NALFD:
-
Non-alcoholic fatty liver disease
- NASH:
-
Non-alcoholic steatohepatitis
- PD(L)-1:
-
Programmed death (ligand) 1
- OS:
-
Overall survival
- PFS:
-
Progression-free survival
- rwTTD:
-
Real-world time to treatment discontinuation
- STROBE:
-
Strengthening the Reporting of Observational Studies in Epidemiology
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Funding
This work was supported by the National Institutes of Health (T32CA009679 and LRP L30CA274783 to TJB). The funder did not play a role in the design of the study; the collection, analysis, and interpretation of the data; the writing of the manuscript; and the decision to submit the manuscript for publication.
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Conceptualization: all authors. Data curation: Brown. Formal Analysis: Brown, Gimotty. Funding acquisition: All authors. Investigation: Brown. Methodology: all authors. Project administration: Yang. Resources: Yang. Software: Brown. Supervision: Yang. Validation: Yang. Visualization: Brown. Writing: original draft: Brown. Writing: review and editing: all Authors.
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Brown, T.J., Mamtani, R., Gimotty, P.A. et al. Outcomes of hepatocellular carcinoma by etiology with first-line atezolizumab and bevacizumab: a real-world analysis. J Cancer Res Clin Oncol 149, 2345–2354 (2023). https://doi.org/10.1007/s00432-023-04590-9
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DOI: https://doi.org/10.1007/s00432-023-04590-9