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Cancer Research and Treatment > Accepted Articles
doi: https://doi.org/10.4143/crt.2024.283    [Accepted]
Clinical and Radiologic Predictors of Response to Atezolizumab-Bevacizumab in Advanced Hepatocellular Carcinoma
Se Jin Choi1 , Sung Won Chung2 , Jonggi Choi2, Kang Mo Kim2, Hyung-Don Kim3, Changhoon Yoo3, Baek-Yeol Ryoo3, Seung Soo Lee1, Won-Mook Choi2 , Sang Hyun Choi1
1Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
2Department of Gastroenterology, Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
3Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
Correspondence  Won-Mook Choi ,Tel: 82-2-3010-0048, Fax: 82-2-485-5782, Email: dr.choi85@gmail.com
Sang Hyun Choi ,Tel: 82-2-3010-1797, Fax: 82-2-476-0090, Email: edwardchoi83@gmail.com
Received: March 9, 2024;  Accepted: May 4, 2024.  Published online: May 7, 2024.
*Se Jin Choi and Sung Won Chung contributed equally to this work.
ABSTRACT
Purpose
This study aimed to identify clinical and radiologic characteristics that could predict response to atezolizumab-bevacizumab combination therapy in patients with advanced hepatocellular carcinoma (HCC).
Materials and Methods
This single-center retrospective study included 108 advanced HCC patients with intrahepatic lesions who were treated with atezolizumab-bevacizumab. Two radiologists independently analyzed Imaging characteristics of the index tumor on pretreatment computed tomography. Predictive factors associated with progressive disease (PD) at the best response based on Response Evaluation Criteria in Solid Tumors, Version 1.1 were evaluated using logistic regression analysis. Progression-free survival (PFS) was estimated by the Kaplan-Meier method and compared with the log-rank test.
Results
Of 108 patients with a median PFS of 15 weeks, 40 (37.0%) had PD during treatment. Factors associated with PD included the presence of extrahepatic metastases (adjusted odds ratio [aOR], 4.13; 95% confidence interval [CI], 1.19–14.35; p=0.03), the infiltrative appearance of the tumor (aOR, 3.07; 95% CI, 1.05–8.93; p=0.04), and the absence of arterial phase hyperenhancement (APHE) (aOR, 6.34; 95% CI, 2.18–18.47; p<0.001). Patients with two or more of these factors had a PD of 66.7% and a median PFS of 8 weeks, indicating a significantly worse outcome compared to the patients with one or no of these factors.
Conclusion
In patients with advanced HCC treated with atezolizumab-bevacizumab treatment, the absence of APHE, infiltrative appearance of the intrahepatic tumor, and presence of extrahepatic metastases were associated with poor response and survival. Evaluation of early response may be necessary in patients with these factors.
Key words: Hepatocellular carcinoma, Liver, Liver Imaging, Chemotherapy, Neoplasms
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