Safety/efficacy of atezolizumab + bevacizumab during anti‐platelet/anticoagulation therapy in unresectable hepatocellular carcinoma

Background and Aims This study aimed to determine the safety and efficacy of atezolizumab + bevacizumab therapy in hepatocellular carcinoma patients receiving anti‐platelet agents or anticoagulants. Methods Patients were divided into those using (IM out) and those not using (IM in) anti‐platelet agents or anticoagulants, who violated the exclusion criteria of the IMbrave150 trial, and were retrospectively examined. Results The study included 185 patients (IM in: 157; IM out: 28). For first‐line treatment, progression‐free survival was 184 days for IM in and 266 days for IM out (p = .136). Overall survival was 603 days for IM in and not reached for IM out (p = .265), with no significant between‐group difference. Similarly, there were no significant between‐group differences in progression‐free survival or overall survival for later‐line treatment. Haemorrhagic adverse events of ≥grade 3 were observed in 11 IM in patients and 3 IM out patients. No significant factors associated with haemorrhagic adverse events of ≥grade 3 were identified in the multivariate analysis including IM out classification, whose p value was .547. Regarding thrombotic/embolic adverse events in the IM out group, one case of exacerbation of portal vein thrombosis was observed. No deaths were directly attributable to bleeding events or exacerbations of thrombosis. Conclusion Atezolizumab + bevacizumab therapy shows similar safety and efficacy in patients receiving and those not receiving anti‐platelet agents or anticoagulants; therefore, it can be considered for patients with hepatocellular carcinoma receiving anti‐platelet agents or anticoagulants.