Evaluating the real-world impact of atezolizumab and bevacizumab combination in unresectable hepatocellular carcinoma: A south Indian experience.

e16241 Background: The combination of atezolizumab and bevacizumab emerged as first-line systemic therapy in unresectable hepatocellular Carcinoma (uHCC), demonstrating promising efficacy in clinical trials. However, real-world data on its safety and efficacy remains crucial to understanding its broader clinical application . Methods: This retrospective cohort study included uHCC patients treated with atezolizumab and bevacizumab from January 2021 to January 2025 in a tertiary care centre. Data on demographics, clinical characteristics, and outcomes [Progression free survival (PFS), Overall survival (OS), adverse events] were collected. Safety was evaluated through treatment-related adverse events, including immune-related and vascular complications . Results: A total of 21 patients with uHCC were included in the analysis (Table 1). The median age of the cohort was 69 years (59.5–72.5 years), with a male predominance (81%). In terms of liver function, 17 patients (81%) were classified as Child-Pugh class A, while 4 patients (19%) were classified as class B. Oesophageal varices were present in 6 patients (28.6%). The most common aetiology for uHCC was Non-Alcoholic Steatohepatitis (NASH) in 12 patients (57.1%). As per Barcelona clinic liver cancer (BCLC) staging, 4 patients (19%) and 17 patients (81%) were classified as Stage B and C, respectively. Nine patients (42.9%) had alfa feto protein levels greater than 500 ng/ml. Extrahepatic spread was observed in 11 patients (52.4%), and portal vein thrombosis (PVT) was seen in 5 patients (23.8%). The median PFS was 3 months (95% CI: 0.76–5.2), and median OS was 15 months (95% CI: 9.0–20.9). Common treatment related adverse events included elevated liver enzymes (57.1%), raised bilirubin (23.8%), fatigue (19%), hypothyroidism (4.8%) and hemoperitoneum (4.8%). Severe adverse events (grade ≥3) occurred in 9 patients (42%). Conclusions: Systemic therapy in patients with unresectable hepatocellular carcinoma demonstrated modest efficacy, with a median PFS of 3 months and median OS of 15 monthslesser than those reported in clinical trials. This was probably due to the higher incidence of NASH and inclusion of Child B patients. These findings suggest the need for further evaluation in real-world settings. Keywords: Hepatocellular carcinoma, atezolizumab, bevacizumab, overall survival, progression free survival. Baseline characteristics of the included patients. Variables N = 21 Age (years) 69(59.5-72.5) Etiology NASH 12 Alcohol 5 Child Pugh class A 17 B 4 BCLC stage B 4 C 17