• Arif Akyildiz, Deniz Can Guven, Ahmet Anil Ozluk, Rashad Ismayilov, Emel Mutlu, UnalOlcun UmitOUDepartment of Medical Oncology, Bozyaka Education and Research Hospital, Izmir, Turkey., Ibrahim Yildiz, Yakup Iriagac, Serdar Turhal, Sinem Akbas, Ertugrul Bayram, TelliTugba AkinTADepartment of Medical Oncology, Marmara University School of Medicine, Istanbul, Turkey., Fatma Paksoy Turkoz, Melike Ozcelik, Mert Erciyestepe, Oguzhan Selvi, Burcu Gulbagci, Ismail Erturk, Zehra Sucuoglu Isleyen, Seda Kahraman, Mutianur Ozkorkmaz Akdag, Buket Hamitoglu, Ilkay Tugba Unek, Caglar Unal, İlhan Hacibekiroglu, Cagatay Arslan, Abdulmunir Azizy, Kaan Helvaci, Umut Demirci, Omer Dizdar, Mert Basaran, Erdem Goker, Mehmet Ali Sendur, and Suayib Yalcin.
• Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey.
• Medicine (Baltimore). 2023 Nov 10; 102 (45): e35950e35950.

AbstractThe aim of the study was to evaluate the real-world clinical outcomes of atezolizumab and bevacizumab (Atez/Bev) as the initial therapy for advanced hepatocellular carcinoma (HCC). We retrospectively analyzed 65 patients treated with Atez/Bev for advanced HCC from 22 institutions in Turkey between September 2020 and March 2023. Responses were evaluated by RECIST v1.1 criteria. The median progression-free survival (PFS) and overall survival (OS) were calculated using the Kaplan-Meier method. Cox regression model was employed to conduct multivariate analyses. The median age was 65 (range, 22-89) years, and 83.1% of the patients were male. A total of 1.5% achieved a complete response, 35.4% had a partial response, 36.9% had stable disease, and 26.2% had progressive disease. The disease control rate was 73.8% and associated with alpha-fetoprotein levels at diagnosis and concomitant antibiotic use. The incidence rates of any grade and grade ≥ 3 adverse events were 29.2% and 10.7%, respectively. At a median follow-up of 11.3 (3.4-33.3) months, the median PFS and OS were 5.1 (95% CI: 3-7.3) and 18.1 (95% CI: 6.2-29.9) months, respectively. In univariate analyses, ECOG-PS ≥ 1 (relative to 0), Child-Pugh class B (relative to A), neutrophil-to-lymphocyte ratio (NLR) > 2.9 (relative to ≤ 2.9), and concomitant antibiotic use significantly increased the overall risk of mortality. Multivariate analysis revealed that ECOG-PS ≥ 1 (HR: 2.69, P = .02), NLR > 2.9 (HR: 2.94, P = .017), and concomitant antibiotic use (HR: 4.18, P = .003) were independent predictors of OS. Atez/Bev is an effective and safe first-line therapy for advanced-stage HCC in a real-world setting. The survival benefit was especially promising in patients with a ECOG-PS score of 0, Child-Pugh class A, lower NLR, and patients who were not exposed to antibiotics during the treatment.Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.

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