Purpose: Systemic therapy with atezolizumab and bevacizumab can extend life for patients with advanced hepatocellular carcinoma (HCC). However, there is substantial variability in response to therapy and overall survival. Although current prognostic models have been validated in HCC, they primarily consider covariates that may be reflective of the severity of the underlying liver disease of patients with HCC. We developed and internally validated a classification and regression tree (CART) to identify patient characteristics associated with risks of early mortality, at or before 6 months from treatment initiation.
Methods: This retrospective cohort study used the nationwide Flatiron Health electronic health record-derived deidentified database and included patients with a diagnosis of HCC after January 1, 2020, who received initial systemic therapy with atezolizumab and bevacizumab. CART was developed from available baseline clinical and demographic information to predict mortality within 6 months from treatment initiation. Model characteristics were compared to the albumin-bilirubin (ALBI) model and was further validated against a contemporary validation cohort of patients after a data update.
Results: A total of 293 patients were analyzed. The CART identified seven cohorts of patients from baseline demographic and laboratory characteristics. The model had an area under the receiver operating curve (AUROC) of 0.739 (95% CI, 0.683 to 0.794) for predicting 6-month mortality. This model was internally valid and performed more favorably than the ALBI model, which had an AUROC of 0.608 (95% CI, 0.557 to 0.660). The model applied to the contemporary validation cohort (n = 111) had an AUROC of 0.666 (95% CI, 0.506 to 0.826).
Conclusion: Using CART, we identified unique cohorts of patients with HCC treated with atezolizumab and bevacizumab with distinct risks of early mortality. This approach outperformed the ALBI model and used clinical and laboratory characteristics that are readily available to oncologists caring for these patients.
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http://dx.doi.org/10.1200/CCI.23.00220 | DOI Listing |
Int J Mol Sci
December 2024
Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki, Kita 761-0793, Kagawa, Japan.
Systemic therapy for unresectable hepatocellular carcinoma (HCC) has progressed with the development of multiple kinases, such as vascular endothelial growth factor (VEGF) signaling, targeting cancer growth and angiogenesis. Additionally, the efficacy of sorafenib, regorafenib, lenvatinib, ramucirumab, and cabozantinib has been demonstrated in various clinical trials, and they are now widely used in clinical practice. Furthermore, the development of effective immune checkpoint inhibitors has progressed in systemic therapy for unresectable HCC, and atezolizumab + bevacizumab (atezo/bev) therapy and durvalumab + tremelimumab therapy are now recommended as first-line treatment.
View Article and Find Full Text PDFImmunotargets Ther
December 2024
Department of Thoracic Surgery, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008, People's Republic of China.
In recent years, the combination of immune checkpoint inhibitors (ICIs) with antiangiogenic agents has led to significant breakthroughs in cancer treatment. Such as programmed cell death 1 (PD-1), programmed cell death ligand 1 (PD-L1), and cytotoxic T-lymphocyte-associated protein 4 (CTLA-4). Antiangiogenic therapy plays a pivotal role in normalizing blood vessels and remodeling the tumor immune microenvironment while ICIs not only enhance the host's antitumor immune response by blocking negative regulatory signals but also promote vascular normalization.
View Article and Find Full Text PDFJ Gastroenterol Hepatol
January 2025
Department of Nursing, Gifu Kyoritsu University, Ogaki, Japan.
Aim: This study aimed to compare the prognostic performance of the risk models for patients with hepatocellular carcinoma (HCC) receiving atezolizumab and bevacizumab (Atez/Bev) as first-line treatment.
Methods: Among 449 patients included in this retrospective multicenter study, we compared the prognostic performance of 13 risk models for the 12-month and 18-month survival status using area under the curve (AUC), net reclassification improvement (NRI), and relative integrated discrimination improvement (IDI) analysis. We also constructed a calibration plot to assess the fitness of each model.
Clin Transl Med
January 2025
Department of Urology, Second Hospital of Tianjin Medical University, Tianjin, China.
Background: Atezolizumab plus bevacizumab has shown promising efficacy in advanced mucosal melanoma in the multi-centre phase II study. This report updates 3-year survival outcomes and multi-omics analysis to identify potential response biomarkers.
Methods: Forty-three intention-to-treat (ITT) patients received intravenous administration of atezolizumab and bevacizumab every 3 weeks.
Intern Med
January 2025
Department of Medical Oncology, Sapporo Medical University School of Medicine, Japan.
A 65-year-old man with hepatocellular carcinoma and lung metastasis was treated with a combination of atezolizumab and bevacizumab. Subsequently, the patient developed fever and new liver lesions, which were considered to indicate a pseudoprogression. Despite this, the treatment was continued.
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