Second-line treatment patterns and outcomes in advanced HCC after progression on atezolizumab/bevacizumab
Meng Wu, Claudia A M Fulgenzi, Antonio D’Alessio, Alessio Cortellini, Ciro Celsa, Giulia Francesca Manfredi, Bernardo Stefanini, Linda Y. Wu, Yi‐Hsiang Huang, Anwaar Saeed, Angelo Pirozzi, Tiziana Pressiani, Lorenza Rimassa, Martin Schoenlein, Kornelius Schulze, Johann von Felden, Yehia I. Mohamed, Ahmed O. Kaseb, Arndt Vogel, Natascha Roehlen, Marianna Silletta, Naoshi Nishida, Masatoshi Kudo, Caterina Vivaldi, Lorenz Balcar, Bernhard Scheiner, Matthias Pinter, Amit G. Singal, Joshua Glover, Susanna V. Ulahannan, Fredrich Foerster, Arndt Weinmann, Peter R. Galle, Neehar D. Parikh, Wei‐Fan Hsu, Alessandro Parisi, Hong Jae Chon, David J. Pinato, Celina Ang
Abstract
Background & Aims: Atezolizumab/bevacizumab (A/B) is now a standard first-line treatment for advanced hepatocellular carcinoma (HCC), but the optimal second-line regimen is not known. We evaluated real-world treatment patterns and outcomes to investigate factors associated with post-progression survival (PPS). Methods: In this multicenter, international, retrospective study, we examined clinical characteristics and outcomes of patients with advanced HCC who progressed on first-line A/B. The primary outcome of PPS was defined as time from first radiographic progression on A/B to death. Results: 0.256). Conclusions: Continuation of active therapy after A/B progression was independently associated with better survival even after adjusting for baseline disease characteristics. mPPS with IO-based therapy exceeded a year, suggesting that IO continuation post-progression may retain benefit. The precise sequencing of TKI and IO regimens warrants further investigation. Impact and implications: There is currently a lack of level 1 data on second-line treatment options for patients with advanced hepatocellular carcinoma who progress after frontline atezolizumab plus bevacizumab, as all second-line approvals were established during the frontline sorafenib era. Our study aims to fill in some of the knowledge gap by investigating real-world patient outcomes in the second-line treatment setting. Findings from this study show that patients who continued active treatment had improved post-progression survival compared to those who received best supportive care, and medication regimens incorporating tyrosine kinase inhibitors as well as immunotherapy agents were active. These results can help inform clinicians of possible treatment options for patients who progress after frontline atezolizumab plus bevacizumab while we await maturing data from randomized-controlled trials.