Liver-directed RT plus atezolizumab-bevacizumab improves response rates in HCC patients

Adding liver-directed radiation therapy (RT) to atezolizumab and bevacizumab (A/B) produces limited additional toxicity with higher response rates among patients with hepatocellular carcinoma (HCC), reports a recent study. However, substantial differences in baseline characteristics hinder a full interpretation of this data.

Forty-nine patients with HCC naïve to systemic therapy who received A/B with or without liver-directed RT from 1 January 2020 until 1 May 2023 were included in this single-centre retrospective cohort study.

The investigators evaluated safety outcomes, real-world response rates (rwRR), overall survival (OS), and time-to-progression (TTP) from A/B initiation. They also analysed time-to-event outcomes using the Kaplan-Meier methodology. No formal comparisons were conducted due to the anticipated baseline imbalances between cohorts.

Of the 49 patients, 15 were included in the RT group and 34 in the control group. The cohorts showed differences in the presence of ascites, baseline liver dysfunction, infection with hepatitis B, and alcoholic liver disease.

Clinically significant bleeding occurred in one patient (6.7 percent) in the RT group and two patients (5.8 percent) in the control group. One patient (6.7 percent) developed possible RT-induced liver disease.

A significantly higher rwRR was noted in the RT group compared with the control group (73.3 percent vs 17.6 percent). The median OS was 14.4 months in the RT group and 10.8 months in the control group, while the median TTP was 6.4 months with RT compared with 5.8 months in the control group.

“Ongoing trials and trials under development will provide informative data regarding the addition of RT to A/B, particularly to assess the impact on OS and TTP,” the investigators said.