Preprint Article Version 1 Preserved in Portico This version is not peer-reviewed

Real-World Outcomes of Atezolizumab With Bevacizumab Treatment in Hepatocellular Carcinoma Patients: Effectiveness, Esophagogastroduodenoscopy Utilization and Bleeding Complications

Cha Len Lee
* ORCID logo ,
Mark Freeman
,
Kelly W. Burak
ORCID logo ,
Gordon T. Moffat
,
Conor O'Donnell
,
Philip Q. Ding
,
Hanna Lyubetska
,
Brandon M. Meyers
,
Vallerie Gordon
,
Ekaterina Kosyachkova
,
Roxana Bucur
,
Winson Y. Cheung
,
Jennifer J. Knox
,
Vincent C Tam
Version 1 : Received: 30 June 2024 / Approved: 2 July 2024 / Online: 2 July 2024 (06:01:14 CEST)

How to cite: Lee, C. L.; Freeman, M.; Burak, K. W.; Moffat, G. T.; O'Donnell, C.; Ding, P. Q.; Lyubetska, H.; Meyers, B. M.; Gordon, V.; Kosyachkova, E.; Bucur, R.; Cheung, W. Y.; Knox, J. J.; Tam, V. C. Real-World Outcomes of Atezolizumab With Bevacizumab Treatment in Hepatocellular Carcinoma Patients: Effectiveness, Esophagogastroduodenoscopy Utilization and Bleeding Complications. Preprints 2024, 2024070186. https://doi.org/10.20944/preprints202407.0186.v1 Lee, C. L.; Freeman, M.; Burak, K. W.; Moffat, G. T.; O'Donnell, C.; Ding, P. Q.; Lyubetska, H.; Meyers, B. M.; Gordon, V.; Kosyachkova, E.; Bucur, R.; Cheung, W. Y.; Knox, J. J.; Tam, V. C. Real-World Outcomes of Atezolizumab With Bevacizumab Treatment in Hepatocellular Carcinoma Patients: Effectiveness, Esophagogastroduodenoscopy Utilization and Bleeding Complications. Preprints 2024, 2024070186. https://doi.org/10.20944/preprints202407.0186.v1

Abstract

The IMbrave150 trial established atezolizumab with bevacizumab (A+B) as standard care for hepatocellular carcinoma (HCC), recommending an esophagogastroduodenoscopy (EGD) within 6 months of treatment initiation to prevent bleeding from esophagogastric varices. The necessity of mandatory EGD for all patients remains unclear. We retrospectively analyzed 112 HCC patients treated with A+B at five Canadian cancer centers from July 1, 2020, to August 31, 2022. A+B was the first-line therapy for 90% of patients, with median overall survival at 20.3 months and progression-free survival at 9.6 months. There was no survival difference between patients with bleeding and those without. Before A+B, 71%(79) of patients underwent an EGD within 6 months, revealing varices in 41%(32) and requiring intervention in 19%(15). The overall bleeding rate was 15%(17), with GI-specific bleeding occurring in 83%(5) of the EGD group and 17%(1) of the non-EGD group (p=0.24). Non-GI bleeding was observed in 10%(11) of patients. Outcomes for HCC patients treated with A+B in Canada were comparable to IMbrave150. Our study showed twice the rate of varices detection and treatment compared to IMbrave150, reflecting real-world treatment of high-risk populations. There was no increased GI bleeding in patients without pre-treatment EGD, supporting a selective EGD approach.

Keywords

atezolizumab; bevacizumab; hepatocellular carcinoma; EGD; varices; GI bleeding

Subject

Medicine and Pharmacology, Gastroenterology and Hepatology

Copyright: This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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