Improved survival with second-line hepatic arterial infusion chemotherapy after atezolizumab-bevacizumab failure in hepatocellular carcinoma

Ji Yeon Lee; Jaejun Lee; Suho Kim; Jae-Sung Yoo; Ji Hoon Kim; Keungmo Yang; Ji Won Han; Jeong Won Jang; Jong Yong Choi; Seung Kew Yoon; Ho Jong Chun; Jung Suk Oh; Pil Soo Sung

doi:10.3389/fonc.2024.1495321

Improved survival with second-line hepatic arterial infusion chemotherapy after atezolizumab-bevacizumab failure in hepatocellular carcinoma

Front Oncol. 2024 Dec 12:14:1495321. doi: 10.3389/fonc.2024.1495321. eCollection 2024.

Authors

Affiliations

¹ Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
² Division of Hepatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
³ Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
⁴ School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
⁵ Division of Hepatology, Department of Internal Medicine, Uijeongbu St Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.

Abstract

Background: There is no established second-line treatment for hepatocellular carcinoma (HCC) following atezolizumab-bevacizumab (ate-beva) failure. This study assessed the efficacy of hepatic arterial infusion chemotherapy (HAIC) as a salvage therapy by comparing survival outcomes and treatment responses between HAIC as a first-line treatment and as a second-line option after ate-beva failure.

Materials and methods: We retrospectively analyzed 100 patients with advanced HCC treated with HAIC between March 2022 and July 2024. Patients were categorized into two groups: those who received HAIC as initial therapy (first-line HAIC group) and those who received HAIC following ate-beva failure (post-ate-beva group). Survival outcomes were assessed with Kaplan-Meier curves and log-rank tests, and factors associated with survival were identified through Cox regression analysis.

Results: The post-ate-beva group exhibited longer overall survival (OS) (median OS 12.4 months) compared to the first-line HAIC group (median OS 6.8 months) (p = 0.073). Progression-free survival (PFS) was significantly superior in the post-ate-beva group (median PFS 8.2 months) compared to the first-line HAIC group (median PFS 3.1 months) (p = 0.018). The objective response rate was also notably higher in the post-ate-beva group than in the first-line HAIC group (35.3% vs. 18.1%, p = 0.031). In multivariate analysis, HAIC following ate-beva failure, compared to first-line HAIC, was significantly associated with favorable outcomes for both OS (p = 0.014) and PFS (p = 0.006).

Conclusion: The superior survival outcomes and treatment responses observed in the post-ate-beva group suggest that HAIC may be an effective second-line treatment option for advanced HCC following ate-beva therapy failure. However, due to the retrospective nature and small sample size of the study, further prospective studies with larger patient populations are needed to strengthen the evidence.

Keywords: atezolizumab; bevacizumab; carcinoma; hepatic arterial infusion chemotherapy; hepatocellular; immunogenic cell death; immunotherapy ` 2.

Grants and funding

The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. The Basic Science Research Program supported this research through a National Research Foundation of Korea (NRF) funded by the Korean government (MSIT) (grant RS-2024-00337298).