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Perfusion Change of Hepatocellular Carcinoma During Atezolizumab plus Bevacizumab Treatment: A Pilot Study

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Abstract

Purpose

To investigate whether the early perfusion change in hepatocellular carcinoma (HCC) predicts the long-term therapeutic response to atezolizumab plus bevacizumab.

Methods

We retrospectively selected 19 subjects (median age: 62 years, 4 females, and 15 males) having advanced HCC and treated with atezolizumab alone (n = 3) or in combination with bevacizumab (n = 16). The 4-phased CT or MRI imaging was performed for each subject before and at 9 ± 2 and 21 ± 5 weeks after therapy initiation. The tumor-to-liver signal ratio in the arterial phase was used to estimate the tumor perfusion. The change in tumor perfusion from the baseline to the 1st follow-up exam was correlated with the tumor response evaluated using mRECIST at the 2nd follow-up exam. The difference between favorably responding and non-responding groups was statistically analyzed using one-way ANOVA.

Results

The mean tumor long axis in the baseline image was 59 ± 47 mm. The HCC perfusion changes were −26 ± 18% for complete (or partial) response (CR/PR, n = 8), −24 ± 12% for stable disease (SD, n = 8), and 9 ± 13% for progressive disease (PD, n = 3). The HCC perfusion change of the CR/PR groups was significantly lower than that of the PD group (p = 0.0040). The HCC perfusion changes between the SD and PD groups were also significantly different (p = 0.0135). The sensitivity and specificity of the early perfusion change to predict the long-term progression of the disease were 100 and 94%, respectively.

Conclusion

The early change in HCC perfusion may predict the long-term therapeutic response to atezolizumab plus bevacizumab, promoting personalized treatment for HCC patients.

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Data Availability

All data were collected from the UAB clinic database, which is not publicly available.

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Acknowledgements

The authors thank Mr. Morgan Amos, Ms. Amanda Richardson, Ms. Haley Hendrix, and Ms. Brandi Barger for collecting clinical data. This study was supported by the department of radiology incentive grant at UAB and the UAB comprehensive cancer center (grant P30 CA13148).

Funding

This work was supported by the department of radiology incentive grant at UAB and the UAB comprehensive cancer center (grant P30 CA13148).

Author information

Authors and Affiliations

  1. Department of Biomedical Engineering, University of Alabama, Birmingham, AL, 35294, USA

    Ezinwanne Onuoha

  2. Department of Radiology, University of Alabama, Birmingham, AL, 35294, USA

    Andrew D. Smith & Harrison Kim

  3. Department of Surgery, University of Alabama, Birmingham, AL, 35294, USA

    Robert Cannon

  4. Department of Medicine, University of Alabama, Birmingham, AL, 35294, USA

    Moh’d Khushman

Authors
  1. Ezinwanne Onuoha
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  2. Andrew D. Smith
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  4. Moh’d Khushman
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  5. Harrison Kim
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Contributions

All authors contributed to the study’s conception and design. Data collection and analysis were performed by Ezinwanne Onuoha and Andrew Smith. The first draft of the manuscript was written by Ezinwanne Onuoha, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Harrison Kim.

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Ethics Approval

This study was performed in line with the principles of the Declaration of Helsinki.

Consent to Participate

Informed consent was exempted for this retrospective study from UAB IRB.

Consent for Publication

Informed consent was exempted for this retrospective study from UAB IRB.

Competing Interests

The authors declare no competing interests.

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Onuoha, E., Smith, A.D., Cannon, R. et al. Perfusion Change of Hepatocellular Carcinoma During Atezolizumab plus Bevacizumab Treatment: A Pilot Study. J Gastrointest Canc 54, 776–781 (2023). https://doi.org/10.1007/s12029-022-00858-4

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  • DOI: https://doi.org/10.1007/s12029-022-00858-4

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