Cancer Res Treat.  2024 Oct;56(4):1219-1230. 10.4143/crt.2024.283.

Clinical and Radiologic Predictors of Response to Atezolizumab-Bevacizumab in Advanced Hepatocellular Carcinoma

• Choi SJ
• Chung SW
• Choi J
• Kim KM
• Kim HD
• Yoo C
• Ryoo BY
• Lee SS
• Choi WM
• Choi SH

• KMID: 2560255
• DOI: http://doi.org/10.4143/crt.2024.283

Abstract

Purpose
This study aimed to identify clinical and radiologic characteristics that could predict response to atezolizumab-bevacizumab combination therapy in patients with advanced hepatocellular carcinoma (HCC).
Materials and Methods
This single-center retrospective study included 108 advanced HCC patients with intrahepatic lesions who were treated with atezolizumab-bevacizumab. Two radiologists independently analyzed imaging characteristics of the index tumor on pretreatment computed tomography. Predictive factors associated with progressive disease (PD) at the best response based on Response Evaluation Criteria in Solid Tumors, ver. 1.1 were evaluated using logistic regression analysis. Progression-free survival (PFS) was estimated by the Kaplan-Meier method and compared with the log-rank test.
Results
Of 108 patients with a median PFS of 15 weeks, 40 (37.0%) had PD during treatment. Factors associated with PD included the presence of extrahepatic metastases (adjusted odds ratio [aOR], 4.13; 95% confidence interval [CI], 1.19 to 14.35; p=0.03), the infiltrative appearance of the tumor (aOR, 3.07; 95% CI, 1.05 to 8.93; p=0.04), and the absence of arterial-phase hyperenhancement (APHE) (aOR, 6.34; 95% CI, 2.18 to 18.47; p < 0.001). Patients with two or more of these factors had a PD of 66.7% and a median PFS of 8 weeks, indicating a significantly worse outcome compared to the patients with one or no of these factors.
Conclusion
In patients with advanced HCC treated with atezolizumab-bevacizumab treatment, the absence of APHE, infiltrative appearance of the intrahepatic tumor, and presence of extrahepatic metastases were associated with poor response and survival. Evaluation of early response may be necessary in patients with these factors.

Keyword

Hepatocellular carcinoma; Liver; Liver imaging; Drug therapy; Neoplasms

Figure

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  Fig. 1. Flow diagram for patient enrollment. AASLD, American Association for the Study of Liver Diseases; CR, complete response; CT, computed tomography; ECOG, Eastern Cooperative Oncology Group; HCC, hepatocellular carcinoma; PD, progressive disease; PR, partial response; SD, stable disease.

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  Fig. 2. A 57-year-old male with biopsy proven hepatocellular carcinoma in the left hepatic lobe. (A-C) Pretreatment dynamic contrast-enhanced computed tomography showing a 9.8 cm infiltrative mass (arrow) without arterial-phase hyperenhancement (A). Nonsmooth tumor margins (arrows) on portal venous (B) and delayed-phase (C) images with tumor-in-vein in the left portal vein (arrowheads). (D) Metastatic nodules in the left lower lobe (arrow). This patient experienced disease progression after 12.5 weeks.

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  Fig. 3. Nomogram for predicting progressive disease. (A) The nomogram depicts the predicted probability of progressive disease on a scale of 0 to 280, derived from a multivariable logistic regression model. (B) Calibration plot for predicted probability vs. actual probability for progressive disease. The dotted line indicates predicted probability, while the black line represents the actual probability, and the gray zone indicates the 95% confidence intervals. APHE, arterial-phase hyperenhancement.

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  Fig. 4. Kaplan-Meier analyses of progression-free survival outcomes according to the number of significant predictive factors (N=0, N=1, or N ≥ 2). Significant predictive factors include the absence of APHE, the infiltrative appearance of the tumor, and the presence of extrahepatic metastases.

Reference

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