Concurrent Atezolizumab Plus Bevacizumab and High-Dose External Beam Radiotherapy for Highly Advanced Hepatocellular Carcinoma

Atezolizumab plus bevacizumab (atezo-bev) has been recommended for advanced hepatocellular carcinoma (HCC). High-dose external beam radiotherapy (RT) is recognized for its excellent local tumor control. The efficacy and safety of concurrent atezo-bev with RT for highly advanced HCC has been minimall...

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Veröffentlicht in:The oncologist (Dayton, Ohio) Ohio), 2024-07, Vol.29 (7), p.e922-e931
Hauptverfasser: Su, Chung-Wei, Teng, Wei, Shen, Eric Yi-Liang, Huang, Bing-Shen, Lin, Po-Ting, Hou, Ming-Mo, Wu, Tsung-Han, Tsan, Din-Li, Hsieh, Chia-Hsun, Wang, Ching-Ting, Chai, Pei-Mei, Lin, Chun-Yen, Lin, Shi-Ming, Lin, Chen-Chun
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container_issue 7
container_start_page e922
container_title The oncologist (Dayton, Ohio)
container_volume 29
creator Su, Chung-Wei
Teng, Wei
Shen, Eric Yi-Liang
Huang, Bing-Shen
Lin, Po-Ting
Hou, Ming-Mo
Wu, Tsung-Han
Tsan, Din-Li
Hsieh, Chia-Hsun
Wang, Ching-Ting
Chai, Pei-Mei
Lin, Chun-Yen
Lin, Shi-Ming
Lin, Chen-Chun
description Atezolizumab plus bevacizumab (atezo-bev) has been recommended for advanced hepatocellular carcinoma (HCC). High-dose external beam radiotherapy (RT) is recognized for its excellent local tumor control. The efficacy and safety of concurrent atezo-bev with RT for highly advanced HCC has been minimally explored. In this preliminary retrospective study, we assessed patients with highly advanced HCC, characterized by Vp4 portal vein thrombosis or tumors exceeding 50% of liver volume, who received concurrent atezo-bev and RT (group A). Group A included 13 patients who received proton radiation at a dose of 72.6 GyE in 22 fractions, and one patient who received photon radiation at a dose of 54 Gy in 18 fractions. This group was compared with 34 similar patients treated atezo-bev alone as a control (group B). The primary objectives were to evaluate the objective response rate (ORR), overall survival (OS), and safety. Baseline characteristics were similar between groups, except for a higher incidence of Vp4 portal vein thrombosis in group A (78.6% vs. 21.4%, P = .05). Group A achieved a higher ORR (50.0% vs. 11.8%, P 
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High-dose external beam radiotherapy (RT) is recognized for its excellent local tumor control. The efficacy and safety of concurrent atezo-bev with RT for highly advanced HCC has been minimally explored. In this preliminary retrospective study, we assessed patients with highly advanced HCC, characterized by Vp4 portal vein thrombosis or tumors exceeding 50% of liver volume, who received concurrent atezo-bev and RT (group A). Group A included 13 patients who received proton radiation at a dose of 72.6 GyE in 22 fractions, and one patient who received photon radiation at a dose of 54 Gy in 18 fractions. This group was compared with 34 similar patients treated atezo-bev alone as a control (group B). The primary objectives were to evaluate the objective response rate (ORR), overall survival (OS), and safety. Baseline characteristics were similar between groups, except for a higher incidence of Vp4 portal vein thrombosis in group A (78.6% vs. 21.4%, P = .05). Group A achieved a higher ORR (50.0% vs. 11.8%, P &lt; .01) and a longer OS (not reached vs. 5.5 months, P = .01) after a median follow-up of 5.2 months. Multivariate analysis indicated that concurrent RT independently favored longer OS (hazard ratio: 0.18; 95% CI, 0.05-0.63, P &lt; .01). Group A did not increase any grade adverse events (78.6% vs. 58.8%, P = .19) or severe adverse events of grade ≥ 3 (14.3% vs. 14.7%, P = .97) compared to group B. The concurrent high-dose external beam radiotherapy appears to safely enhance the effectiveness of atezolizumab plus bevacizumab for highly advanced patients with HCC. Further studies are warranted to confirm these findings.</description><identifier>ISSN: 1083-7159</identifier><identifier>ISSN: 1549-490X</identifier><identifier>EISSN: 1549-490X</identifier><identifier>DOI: 10.1093/oncolo/oyae048</identifier><identifier>PMID: 38530254</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><subject>Adult ; Aged ; Antibodies, Monoclonal, Humanized - therapeutic use ; Antineoplastic Combined Chemotherapy Protocols - therapeutic use ; Bevacizumab - administration &amp; dosage ; Bevacizumab - therapeutic use ; Cancer ; Carcinoma, Hepatocellular - drug therapy ; Carcinoma, Hepatocellular - pathology ; Carcinoma, Hepatocellular - radiotherapy ; Care and treatment ; Chemoradiotherapy - methods ; Drug therapy, Combination ; Female ; Hepatobiliary ; Hepatoma ; Humans ; Liver Neoplasms - drug therapy ; Liver Neoplasms - pathology ; Liver Neoplasms - radiotherapy ; Male ; Middle Aged ; Oncology, Experimental ; Patient outcomes ; Physiological aspects ; Radiotherapy ; Retrospective Studies ; Treatment outcome</subject><ispartof>The oncologist (Dayton, Ohio), 2024-07, Vol.29 (7), p.e922-e931</ispartof><rights>The Author(s) 2024. 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Published by Oxford University Press. 2024</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><orcidid>0000-0003-2778-3618 ; 0000-0002-2907-2679 ; 0000-0003-3007-3190</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC11224977/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC11224977/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38530254$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Su, Chung-Wei</creatorcontrib><creatorcontrib>Teng, Wei</creatorcontrib><creatorcontrib>Shen, Eric Yi-Liang</creatorcontrib><creatorcontrib>Huang, Bing-Shen</creatorcontrib><creatorcontrib>Lin, Po-Ting</creatorcontrib><creatorcontrib>Hou, Ming-Mo</creatorcontrib><creatorcontrib>Wu, Tsung-Han</creatorcontrib><creatorcontrib>Tsan, Din-Li</creatorcontrib><creatorcontrib>Hsieh, Chia-Hsun</creatorcontrib><creatorcontrib>Wang, Ching-Ting</creatorcontrib><creatorcontrib>Chai, Pei-Mei</creatorcontrib><creatorcontrib>Lin, Chun-Yen</creatorcontrib><creatorcontrib>Lin, Shi-Ming</creatorcontrib><creatorcontrib>Lin, Chen-Chun</creatorcontrib><title>Concurrent Atezolizumab Plus Bevacizumab and High-Dose External Beam Radiotherapy for Highly Advanced Hepatocellular Carcinoma</title><title>The oncologist (Dayton, Ohio)</title><addtitle>Oncologist</addtitle><description>Atezolizumab plus bevacizumab (atezo-bev) has been recommended for advanced hepatocellular carcinoma (HCC). 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Group A achieved a higher ORR (50.0% vs. 11.8%, P &lt; .01) and a longer OS (not reached vs. 5.5 months, P = .01) after a median follow-up of 5.2 months. Multivariate analysis indicated that concurrent RT independently favored longer OS (hazard ratio: 0.18; 95% CI, 0.05-0.63, P &lt; .01). Group A did not increase any grade adverse events (78.6% vs. 58.8%, P = .19) or severe adverse events of grade ≥ 3 (14.3% vs. 14.7%, P = .97) compared to group B. The concurrent high-dose external beam radiotherapy appears to safely enhance the effectiveness of atezolizumab plus bevacizumab for highly advanced patients with HCC. 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High-dose external beam radiotherapy (RT) is recognized for its excellent local tumor control. The efficacy and safety of concurrent atezo-bev with RT for highly advanced HCC has been minimally explored. In this preliminary retrospective study, we assessed patients with highly advanced HCC, characterized by Vp4 portal vein thrombosis or tumors exceeding 50% of liver volume, who received concurrent atezo-bev and RT (group A). Group A included 13 patients who received proton radiation at a dose of 72.6 GyE in 22 fractions, and one patient who received photon radiation at a dose of 54 Gy in 18 fractions. This group was compared with 34 similar patients treated atezo-bev alone as a control (group B). The primary objectives were to evaluate the objective response rate (ORR), overall survival (OS), and safety. Baseline characteristics were similar between groups, except for a higher incidence of Vp4 portal vein thrombosis in group A (78.6% vs. 21.4%, P = .05). Group A achieved a higher ORR (50.0% vs. 11.8%, P &lt; .01) and a longer OS (not reached vs. 5.5 months, P = .01) after a median follow-up of 5.2 months. Multivariate analysis indicated that concurrent RT independently favored longer OS (hazard ratio: 0.18; 95% CI, 0.05-0.63, P &lt; .01). Group A did not increase any grade adverse events (78.6% vs. 58.8%, P = .19) or severe adverse events of grade ≥ 3 (14.3% vs. 14.7%, P = .97) compared to group B. The concurrent high-dose external beam radiotherapy appears to safely enhance the effectiveness of atezolizumab plus bevacizumab for highly advanced patients with HCC. Further studies are warranted to confirm these findings.</abstract><cop>England</cop><pub>Oxford University Press</pub><pmid>38530254</pmid><doi>10.1093/oncolo/oyae048</doi><orcidid>https://orcid.org/0000-0003-2778-3618</orcidid><orcidid>https://orcid.org/0000-0002-2907-2679</orcidid><orcidid>https://orcid.org/0000-0003-3007-3190</orcidid><oa>free_for_read</oa></addata></record>
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subjects Adult
Aged
Antibodies, Monoclonal, Humanized - therapeutic use
Antineoplastic Combined Chemotherapy Protocols - therapeutic use
Bevacizumab - administration & dosage
Bevacizumab - therapeutic use
Cancer
Carcinoma, Hepatocellular - drug therapy
Carcinoma, Hepatocellular - pathology
Carcinoma, Hepatocellular - radiotherapy
Care and treatment
Chemoradiotherapy - methods
Drug therapy, Combination
Female
Hepatobiliary
Hepatoma
Humans
Liver Neoplasms - drug therapy
Liver Neoplasms - pathology
Liver Neoplasms - radiotherapy
Male
Middle Aged
Oncology, Experimental
Patient outcomes
Physiological aspects
Radiotherapy
Retrospective Studies
Treatment outcome
title Concurrent Atezolizumab Plus Bevacizumab and High-Dose External Beam Radiotherapy for Highly Advanced Hepatocellular Carcinoma
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