Impact of body mass index in patients receiving atezolizumab plus bevacizumab for hepatocellular carcinoma

  • Mathew Vithayathil
  • Antonio D'Alessio
  • Claudia Angela Maria Fulgenzi
  • Naoshi Nishida
  • Martin Schönlein
  • Johann von Felden
  • Kornelius Schulze
  • Henning Wege
  • Anwaar Saeed
  • Brooke Wietharn
  • Hannah Hildebrand
  • Linda Wu
  • Celina Ang
  • Thomas U Marron
  • Arndt Weinmann
  • Peter R Galle
  • Dominik Bettinger
  • Bertram Bengsch
  • Arndt Vogel
  • Lorenz Balcar
  • Bernhard Scheiner
  • Pei-Chang Lee
  • Yi-Hsiang Huang
  • Suneetha Amara
  • Mahvish Muzaffar
  • Abdul Rafeh Naqash
  • Antonella Cammarota
  • Valentina Zanuso
  • Tiziana Pressiani
  • Matthias Pinter
  • Alessio Cortellini
  • Masatoshi Kudo
  • Lorenza Rimassa
  • David J Pinato
  • Rohini Sharma

Abstract

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.

Bibliographical data

Original languageEnglish
ISSN1936-0533
DOIs
Publication statusPublished - 08.2023
PubMed 37005953