Impact of older age in patients receiving atezolizumab and bevacizumab for hepatocellular carcinoma

BACKGROUND AND AIMS: Combination atezolizumab/bevacizumab is the gold standard for first line-treatment of unresectable hepatocellular carcinoma (HCC). Our study investigated the efficacy and safety of combination therapy in older patients with HCC.

METHODS: 191 consecutive patients from eight centres receiving atezolizumab and bevacizumab were included. Overall survival (OS), progression-free survival (PFS), overall response rate (ORR) and disease control rate (DCR) defined by RECIST v1.1 were measured in older (age≥65 years) and younger (age<65 years) age patients. Treatment-related adverse events (trAEs) were evaluated.

RESULTS: The elderly (n=116) had higher rates of non-alcoholic fatty liver disease (19.8% vs. 2.7%; p<0.001), presenting with smaller tumours (6.2cm vs 7.9cm, p=0.02) with less portal vein thrombosis (31.9 vs. 54.7%, p=0.002), with fewer patients presenting with BCLC-C stage disease (50.9 vs. 74.3%, p=0.002). There was no significant difference in OS (median 14.9 vs. 15.1 months; HR 1.15, 95% CI 0.65-2.02 p=0.63) and PFS (median 7.1 vs. 5.5 months; HR 1.11, 95% CI 0.54-1.92; p=0.72) between older age and younger age. Older patients had similar ORR (27.6% vs. 20.0%; p=0.27) and DCR (77.5% vs. 66.1%; p=0.11) compared to younger patients. Atezolizumab-related (40.5% vs. 48.0%; p=0.31) and bevacizumab-related (44.8% vs. 41.3%; p=0.63) trAEs were comparable between groups. Rates of grade ≥3 trAEs and toxicity-related treatment discontinuation were similar between older and younger age patients. Patients 75 years and older had similar survival and safety outcomes compared to younger patients.

CONCLUSIONS: Atezolizumab and bevacizumab therapy is associated with comparable efficacy and tolerability in older age patients with unresectable HCC.