P-34 ALBUMIN-BILIRUBIN GRADE ANALYSIS OF OVERALL SURVIVAL WITH ATEZOLIZUMAB PLUS BEVACIZUMAB IN PATIENTS WITH UNRESECTABLE HEPATOCELLULAR CARCINOMA

No Atezolizumab-bevacizumab (atezo-bev) is currently recommended as first-line therapy for patients with unresectable hepatocellular carcinoma (uHCC). However, its effectiveness in patients with albumin-bilirrubin (ALBI) grade 2 has been questioned in a recent post-hoc analysis of the Phase III IMbrave 150 study, which showed that atezo-bev had a similar overall survival (OS) compared to sorafenibe in that population. To evaluate the impact of ALBI grade on OS in patients with uHCC treated as first-line systemic therapy with atezo-bev. This prospective cohort study was conducted in Hospital de Clinicas de Porto Alegre and Hospital Moinhos de Vento, two tertiary healthcare centers in the city of Porto Alegre, Brazil. It comprised all Child A patients with uHCC that started atezo-bev as first line therapy between August 2020 and May 2023. ALBI grade within 30 days of treatment initiation was calculated using MDCalc, available online free of charge. Mean OS was established for patients with ALBI-1 versus ALBI-2 and 3. A total of 20 Child A patients with uHCC were included, 1 classified as Barcelona Clinic Liver Cancer B (BCLC-B) and 19 as BCLC-C. Mean age was 65 years, 75.6% were males and all were cirrhotic. According to ALBI grade, 10 patients were classified as ALBI-1 and 10 as ALBI non-1 (9 grade 2 and 1 grade 3). Mean OS among those with ALBI-1 was 56.3 weeks and among those with ALBI non-1 was 32 weeks (P<0.05). Macrovascular invasion (MVI) was similar in ALBI-1 vs non-1 (40% vs 50%, respectively). However, variceal bleeding during atezo-bev was remarkably different among ALBI-1 vs non-1 patients (0 vs 50%, respectively). Overall, the findings of this study showed that the baseline ALBI grade was superior to Child score in predicting the prognosis of patients with uHCC treated with atezo-bev.