TY - JOUR
T1 - Impact of body mass index in patients receiving atezolizumab plus bevacizumab for hepatocellular carcinoma
AU - Vithayathil, Mathew
AU - D’Alessio, Antonio
AU - Fulgenzi, Claudia Angela Maria
AU - Nishida, Naoshi
AU - Schönlein, Martin
AU - von Felden, Johann
AU - Schulze, Kornelius
AU - Wege, Henning
AU - Saeed, Anwaar
AU - Wietharn, Brooke
AU - Hildebrand, Hannah
AU - Wu, Linda
AU - Ang, Celina
AU - Marron, Thomas U.
AU - Weinmann, Arndt
AU - Galle, Peter R.
AU - Bettinger, Dominik
AU - Bengsch, Bertram
AU - Vogel, Arndt
AU - Balcar, Lorenz
AU - Scheiner, Bernhard
AU - Lee, Pei Chang
AU - Huang, Yi Hsiang
AU - Amara, Suneetha
AU - Muzaffar, Mahvish
AU - Naqash, Abdul Rafeh
AU - Cammarota, Antonella
AU - Zanuso, Valentina
AU - Pressiani, Tiziana
AU - Pinter, Matthias
AU - Cortellini, Alessio
AU - Kudo, Masatoshi
AU - Rimassa, Lorenza
AU - Pinato, David J.
AU - Sharma, Rohini
N1 - Publisher Copyright:
© 2023, The Author(s).
PY - 2023/8
Y1 - 2023/8
N2 - Background: Atezolizumab plus bevacizumab (Atezo/Bev) is first line-treatment for unresectable hepatocellular carcinoma (HCC). Body mass index (BMI) has demonstrated predictive value for response to immunotherapy in non-HCC cancer types. Our study investigated the effect of BMI on safety and efficacy of real-life use of Atezo/Bev for unresectable HCC. Methods: 191 consecutive patients from seven centres receiving Atezo/Bev were included in the retrospective study. Overall survival (OS), progression-free survival (PFS), overall response rate (ORR) and disease control rate (DCR) defined by RECIST v1.1 were measured in overweight (BMI ≥ 25) and non-overweight (BMI < 25) patients. Treatment-related adverse events (trAEs) were evaluated. Results: Patients in the overweight cohort (n = 94) had higher rates of non-alcoholic fatty liver disease (NAFLD) and lower rates of Hepatitis B compared to non-overweight cohort (n = 97). Baseline Child–Pugh class and Barcelona Clinic Liver Cancer stage were similar between cohorts, with lower rates of extrahepatic spread in the overweight group. Overweight patients had similar OS compared to non-overweight (median OS 15.1 vs. 14.9 months; p = 0.99). BMI did not influence median PFS (7.1 vs. 6.1 months; p = 0.42), ORR (27.2% vs. 22.0%; p = 0.44) and DCR (74.1% vs. 71.9%; p = 0.46). There were higher rates of atezolizumab-related fatigue (22.3% vs. 10.3%; p = 0.02) and bevacizumab-related thrombosis (8.5% vs. 2.1%; p = 0.045) in the overweight patients, but overall trAEs and treatment discontinuation were comparable between cohorts. Conclusion: Atezo/Bev has comparable efficacy in overweight HCC patients, with an increase in treatment-related fatigue and thrombosis. Combination therapy is safe and efficacious to use in overweight patients, including those with underlying NAFLD.
AB - Background: Atezolizumab plus bevacizumab (Atezo/Bev) is first line-treatment for unresectable hepatocellular carcinoma (HCC). Body mass index (BMI) has demonstrated predictive value for response to immunotherapy in non-HCC cancer types. Our study investigated the effect of BMI on safety and efficacy of real-life use of Atezo/Bev for unresectable HCC. Methods: 191 consecutive patients from seven centres receiving Atezo/Bev were included in the retrospective study. Overall survival (OS), progression-free survival (PFS), overall response rate (ORR) and disease control rate (DCR) defined by RECIST v1.1 were measured in overweight (BMI ≥ 25) and non-overweight (BMI < 25) patients. Treatment-related adverse events (trAEs) were evaluated. Results: Patients in the overweight cohort (n = 94) had higher rates of non-alcoholic fatty liver disease (NAFLD) and lower rates of Hepatitis B compared to non-overweight cohort (n = 97). Baseline Child–Pugh class and Barcelona Clinic Liver Cancer stage were similar between cohorts, with lower rates of extrahepatic spread in the overweight group. Overweight patients had similar OS compared to non-overweight (median OS 15.1 vs. 14.9 months; p = 0.99). BMI did not influence median PFS (7.1 vs. 6.1 months; p = 0.42), ORR (27.2% vs. 22.0%; p = 0.44) and DCR (74.1% vs. 71.9%; p = 0.46). There were higher rates of atezolizumab-related fatigue (22.3% vs. 10.3%; p = 0.02) and bevacizumab-related thrombosis (8.5% vs. 2.1%; p = 0.045) in the overweight patients, but overall trAEs and treatment discontinuation were comparable between cohorts. Conclusion: Atezo/Bev has comparable efficacy in overweight HCC patients, with an increase in treatment-related fatigue and thrombosis. Combination therapy is safe and efficacious to use in overweight patients, including those with underlying NAFLD.
KW - Anti-programmed death-ligand
KW - Anti-vascular endothelial growth factor
KW - Checkpoint inhibitor
KW - Cirrhosis
KW - Immunotherapy
KW - Non-alcoholic fatty liver disease
KW - Obesity
KW - Overall survival
KW - Overweight
KW - Progression-free survival
UR - http://www.scopus.com/inward/record.url?scp=85151455358&partnerID=8YFLogxK
U2 - 10.1007/s12072-023-10491-3
DO - 10.1007/s12072-023-10491-3
M3 - Article
SN - 1936-0533
VL - 17
SP - 904
EP - 914
JO - Hepatology International
JF - Hepatology International
IS - 4
ER -
