Safety and Efficacy of Atezolizumab/Bevacizumab in Patients with Hepatocellular Carcinoma and Impaired Liver Function: A Systematic Review and Meta-Analysis
Background: Safety and outcome of atezolizumab/bevacizumab in Child-Pugh B patients with hepatocellular carcinoma (HCC) have not been completely characterized. Objectives: In this study, we aimed at addressing safety and efficacy of atezolizumab/bevacizumab in Child-Pugh B patients by reviewing the...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Karger Publishers
2023-10-01
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| Series: | Liver Cancer |
| Subjects: | |
| Online Access: | https://beta.karger.com/Article/FullText/533991 |
| _version_ | 1827766671160377344 |
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| author | Andrea Pasta Francesco Calabrese Ariel Jaffe Sara Labanca Simona Marenco Giulia Pieri Maria Corina Plaz Torres Mario Strazzabosco Edoardo G. Giannini |
| author_facet | Andrea Pasta Francesco Calabrese Ariel Jaffe Sara Labanca Simona Marenco Giulia Pieri Maria Corina Plaz Torres Mario Strazzabosco Edoardo G. Giannini |
| author_sort | Andrea Pasta |
| collection | DOAJ |
| description | Background: Safety and outcome of atezolizumab/bevacizumab in Child-Pugh B patients with hepatocellular carcinoma (HCC) have not been completely characterized. Objectives: In this study, we aimed at addressing safety and efficacy of atezolizumab/bevacizumab in Child-Pugh B patients by reviewing the available data and analyzing them by meta-analysis. Methods: We compared the safety and efficacy of atezolizumab/becavizumab treatment in patients with unresectable HCC and various degrees of liver dysfunction. A total of 8 retrospective, non-randomized, cohort studies were included in this meta-analysis, for a total of 1,071 Child-Pugh A and 225 Child-Pugh B patients. The albumin-bilirubin (ALBI) grade was also used to assess liver function, when available. Results: Grade ≥3 adverse events were observed in 11.8% of Child-Pugh class A and 26.8% class B patients (p = 0.0001), with an odds ratio (OR) of 0.43 (confidence interval [CI] 0.21–0.90; p = 0.02). Progression-free survival (PFS) at both 6 months (4.90 ± 2.08 vs. 4.75 ± 2.08 months; p = 0.0004) and 12 months (8.83 ± 2.32 vs. 7.26 ± 2.33 months; p = 0.002) was lower in Child-Pugh class B patients. A trend toward a higher objective response rate (ORR) was observed in Child-Pugh class A patients (219/856, 25.6%) as compared to Child-Pugh class B patients (25/138, 18.1%; p = 0.070), while the probability of obtaining an ORR was significantly greater in Child-Pugh A patients (OR 1.79, CI 1.12–2.86; p = 0.02). Median overall survival (OS) was 16.8 ± 2.0 and 6.8 ± 3.2 months in Child-Pugh A and B patients, respectively (mean difference 9.06 months, CI 7.01–11.1, p < 0.0001). Lastly, OS was longer in patients with ALBI grades 1–2 than in those with grade 3 (8.3 ± 11.4 vs. 3.3 ± 5.0 months, p = 0.0008). Conclusions: Oncological efficacy of atezolizumab/bevacizumab is moderate in Child-Pugh class B patients, and the shorter PFS and OS associated with the greater likelihood of experiencing treatment-related adverse events observed in these patients suggest great caution and individualization of treatment, possibly with the support of the ALBI grade. |
| first_indexed | 2024-03-11T11:45:15Z |
| format | Article |
| id | doaj.art-1585a857883b40ff992d7e92b5493248 |
| institution | Directory Open Access Journal |
| issn | 1664-5553 |
| language | English |
| last_indexed | 2024-03-11T11:45:15Z |
| publishDate | 2023-10-01 |
| publisher | Karger Publishers |
| record_format | Article |
| series | Liver Cancer |
| spelling | doaj.art-1585a857883b40ff992d7e92b54932482023-11-09T13:57:54ZengKarger PublishersLiver Cancer1664-55532023-10-0111110.1159/000533991533991Safety and Efficacy of Atezolizumab/Bevacizumab in Patients with Hepatocellular Carcinoma and Impaired Liver Function: A Systematic Review and Meta-AnalysisAndrea Pasta0Francesco Calabrese1Ariel Jaffe2Sara Labanca3Simona Marenco4Giulia Pieri5Maria Corina Plaz Torres6Mario Strazzabosco7Edoardo G. Giannini8Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, ItalyGastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, ItalyDepartment of Internal Medicine, Liver Center, Yale University School of Medicine, New Haven, CT, USAGastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, ItalyGastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, ItalyGastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, ItalyGastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, ItalyDepartment of Internal Medicine, Liver Center, Yale University School of Medicine, New Haven, CT, USAGastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, ItalyBackground: Safety and outcome of atezolizumab/bevacizumab in Child-Pugh B patients with hepatocellular carcinoma (HCC) have not been completely characterized. Objectives: In this study, we aimed at addressing safety and efficacy of atezolizumab/bevacizumab in Child-Pugh B patients by reviewing the available data and analyzing them by meta-analysis. Methods: We compared the safety and efficacy of atezolizumab/becavizumab treatment in patients with unresectable HCC and various degrees of liver dysfunction. A total of 8 retrospective, non-randomized, cohort studies were included in this meta-analysis, for a total of 1,071 Child-Pugh A and 225 Child-Pugh B patients. The albumin-bilirubin (ALBI) grade was also used to assess liver function, when available. Results: Grade ≥3 adverse events were observed in 11.8% of Child-Pugh class A and 26.8% class B patients (p = 0.0001), with an odds ratio (OR) of 0.43 (confidence interval [CI] 0.21–0.90; p = 0.02). Progression-free survival (PFS) at both 6 months (4.90 ± 2.08 vs. 4.75 ± 2.08 months; p = 0.0004) and 12 months (8.83 ± 2.32 vs. 7.26 ± 2.33 months; p = 0.002) was lower in Child-Pugh class B patients. A trend toward a higher objective response rate (ORR) was observed in Child-Pugh class A patients (219/856, 25.6%) as compared to Child-Pugh class B patients (25/138, 18.1%; p = 0.070), while the probability of obtaining an ORR was significantly greater in Child-Pugh A patients (OR 1.79, CI 1.12–2.86; p = 0.02). Median overall survival (OS) was 16.8 ± 2.0 and 6.8 ± 3.2 months in Child-Pugh A and B patients, respectively (mean difference 9.06 months, CI 7.01–11.1, p < 0.0001). Lastly, OS was longer in patients with ALBI grades 1–2 than in those with grade 3 (8.3 ± 11.4 vs. 3.3 ± 5.0 months, p = 0.0008). Conclusions: Oncological efficacy of atezolizumab/bevacizumab is moderate in Child-Pugh class B patients, and the shorter PFS and OS associated with the greater likelihood of experiencing treatment-related adverse events observed in these patients suggest great caution and individualization of treatment, possibly with the support of the ALBI grade.https://beta.karger.com/Article/FullText/533991survivalbenefitcirrhosissystemic treatment |
| spellingShingle | Andrea Pasta Francesco Calabrese Ariel Jaffe Sara Labanca Simona Marenco Giulia Pieri Maria Corina Plaz Torres Mario Strazzabosco Edoardo G. Giannini Safety and Efficacy of Atezolizumab/Bevacizumab in Patients with Hepatocellular Carcinoma and Impaired Liver Function: A Systematic Review and Meta-Analysis Liver Cancer survival benefit cirrhosis systemic treatment |
| title | Safety and Efficacy of Atezolizumab/Bevacizumab in Patients with Hepatocellular Carcinoma and Impaired Liver Function: A Systematic Review and Meta-Analysis |
| title_full | Safety and Efficacy of Atezolizumab/Bevacizumab in Patients with Hepatocellular Carcinoma and Impaired Liver Function: A Systematic Review and Meta-Analysis |
| title_fullStr | Safety and Efficacy of Atezolizumab/Bevacizumab in Patients with Hepatocellular Carcinoma and Impaired Liver Function: A Systematic Review and Meta-Analysis |
| title_full_unstemmed | Safety and Efficacy of Atezolizumab/Bevacizumab in Patients with Hepatocellular Carcinoma and Impaired Liver Function: A Systematic Review and Meta-Analysis |
| title_short | Safety and Efficacy of Atezolizumab/Bevacizumab in Patients with Hepatocellular Carcinoma and Impaired Liver Function: A Systematic Review and Meta-Analysis |
| title_sort | safety and efficacy of atezolizumab bevacizumab in patients with hepatocellular carcinoma and impaired liver function a systematic review and meta analysis |
| topic | survival benefit cirrhosis systemic treatment |
| url | https://beta.karger.com/Article/FullText/533991 |
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