Effectiveness and Safety of Atezolizumab Plus Bevacizumab in Unresectable Hepatocellular Carcinoma: A Multicenter, Retrospective Real-World Study in China

Background: Atezolizumab combined with bevacizumab (Atezo + Bev) has received regulatory approval as a first-line systemic therapy for unresectable hepatocellular carcinoma. This study aimed to evaluate the effectiveness and safety of atezolizumab combined with bevacizumab (Atezo + Bev) in treating unresectable hepatocellular carcinoma (uHCC) in a real-world Chinese population, focusing on both first-line and second-line treatment settings. Methods: In this multicenter, retrospective study, patients with uHCC treated with Atezo + Bev were included at 5 centers in China from Jan. 2021 to Jan. 2023. Treatment efficacy was assessed using RECIST 1.1 and mRECIST criteria. Overall response (ORR), disease control rates (DCRs), time to disease progression (TPP), progression-free survival (PFS), and overall survival (OS) were calculated. Results: The study included 48 patients, with a median age of 58 years, among which 35 and 13 patients received Atezo + Bev as first- and second-line treatment, respectively. The ORR and DCR were 39.6% and 70.8% according to RECIST 1.1, and 60.4% and 75.0% according to mRECIST, respectively. With a median follow-up of 14.5 months, the median PFS was 8.5 months (95% CI [4.4, 11.2]) in the first-line treatment group, while in the second-line group it was 5.1 months (95% CI [2.1, 7.9]). The median OS was not reached. Adverse events of any grade were observed in 75% of patients (n = 36), most commonly being thrombocytopenia (27.1%), lymphopenia (25%), and abnormal liver function (14.6%). Conclusion: This study confirmed the practical efficacy and safety of Atezo + Bev in real-world Chinese patients with uHCC, both as a first-line and second-line treatment. Further studies are warranted to validate these findings and optimize treatment strategies.