The initial therapeutic response in patients with unresectable hepatocellular carcinoma treated with atezolizumab plus bevacizumab contributes to the change of liver function during treatment: A multicenter analysis

BACKGROUND: Therapeutic response in patients with unresectable hepatocellular carcinoma (HCC) receiving multikinase inhibitors is associated with changes in liver function. However, limited data are available for patients treated with atezolizumab plus bevacizumab (ATZ/BEV). METHODS: We retrospectively enrolled 151 patients with unresectable HCC who received ATZ/BEV as first-line systemic therapy. Liver function was assessed using albumin-bilirubin (ALBI) score at baseline (pre-ALBI) and 6 weeks after the initiation of ATZ/BEV (6W-ALBI). We evaluated the dynamic relationship between initial therapeutic response and changes in ALBI score (6W-ALBI - pre-ALBI), and examined the prognostic impact of pre-ALBI, 6W-ALBI, and ALBI score changes. RESULTS: Patients achieving an initial complete or partial response (CR+PR) showed a significantly higher rate of improvement in ALBI score from baseline to 6W after the initiation of ATZ/BEV than those with stable or progressive disease (SD+PD) at the initial treatment response (46% vs. 25%, respectively, P = 0.018). Among patients with baseline ALBI grade ≥2, changes in ALBI score differed significantly between the groups (median change: CR+PR vs SD+PD, -0.03 vs. 0.18, respectively, P = 0.048). Time-dependent receiver operating characteristic analysis demonstrated 6W-ALBI had the best predictive ability for overall survival (OS) at 12 months after the ATZ/BEV initiation (optimal cut-off -1.95, area under the curve: 0.763). Using this cut-off, 6W-ALBI was independently associated with OS in multivariate analysis (hazard ratio: 2.40, P = 0.004). CONCLUSIONS: Initial therapeutic response to ATZ/BEV was associated with changes in liver function. The ALBI score during ATZ/BEV may serve as a prognostic indicator.