Dr. Ahn on Treatment Considerations With Atezolizumab/Bevacizumab in Unresectable HCC

Daniel H. Ahn, DO, an oncologist, internist, and assistant professor of medicine at Mayo Clinic, discusses considerations for treatment with atezolizumab (Tecentriq) and bevacizumab (Avastin) in patients with hepatocellular carcinoma (HCC).

Patients who are not eligible for surgical resection or transplantation, given the high association of liver sorosis in HCC, are eligible for systemic therapy, according to Ahn. Most patients will be candidates for treatment with atezolizumab/bevacizumab unless counter indicated.

These counter indications include immune-related comorbidities, such as autoimmune conditions or prior exposure to an immune checkpoint inhibitor with significant treatment-associated toxicity. Additionally, patients who were not eligible to receive an anti-angiogenic inhibitor would not be candidates for treatment with the combination.

As part of enrollment criteria for the phase 3 IMbrave150 trial (NCT03434379), which examined the combination in unresectable HCC vs sorafenib (Nexavar), patients were required to have adequately treated esophageal varices, as well as undergo esophagogastroduodenoscopy screening and appropriate medical management, Ahn says. In patients who were appropriately managed, the risk for grade 3 or higher bleeding was very minimal and only slightly higher vs sorafenib. Provided that patients are appropriately screened and treated, the combination can be safe and effective, Ahn concludes.