Suboptimal outcomes of sorafenib as a second-line treatment after atezolizumab-bevacizumab for unresectable hepatocellular carcinoma

Dig Liver Dis. 2024 Dec;56(12):2079-2084. doi: 10.1016/j.dld.2024.07.035. Epub 2024 Aug 20.

Abstract

Background: Most patients receiving atezolizumab-bevacizumab (AB) for hepatocellular carcinoma will eventually experience disease progression. Randomized clinical trials (RCTs) are undergoing to identify second-line treatments. Where RCTs are unavailable or patients are non-eligible, sorafenib is often prescribed based on approval and reimbursement policies. However, evidence supporting this approach is minimal.

Objective: To assess the efficacy and safety of sorafenib in patients who permanently discontinued AB.

Methods: The ARTE database prospectively collects patients treated with AB in a real-life setting. We analysed the outcome of patients who received sorafenib as second-line treatment.

Results: Amongst 213 patients, 130 (61.0 %) permanently discontinued AB. Of them, 54 received second- line treatments, and sorafenib was prescribed in 40 patients. The disease control rate (DCR) was 10.0 %. The median progression-free (PFS) and overall survival were 3.3 (95 % confidence interval [CI] 2.7-3.9) and 6.9 months (95 % CI 2.7-11.1), respectively.

Conclusions: In patients progressing under AB, the efficacy of sorafenib on different outcomes is limited.

Keywords: Hepatocellular carcinoma; Immunotherapy; Outcome; Sorafenib; Tyrosine kinase inhibitors.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Antibodies, Monoclonal, Humanized* / administration & dosage
  • Antibodies, Monoclonal, Humanized* / adverse effects
  • Antibodies, Monoclonal, Humanized* / therapeutic use
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Bevacizumab* / administration & dosage
  • Bevacizumab* / therapeutic use
  • Carcinoma, Hepatocellular* / drug therapy
  • Carcinoma, Hepatocellular* / mortality
  • Female
  • Humans
  • Liver Neoplasms* / drug therapy
  • Liver Neoplasms* / mortality
  • Male
  • Middle Aged
  • Progression-Free Survival
  • Prospective Studies
  • Sorafenib* / therapeutic use

Substances

  • Sorafenib
  • Bevacizumab
  • atezolizumab
  • Antibodies, Monoclonal, Humanized