Certain HCC patients on atezolizumab–bevacizumab combo at risk of variceal bleeding

Patients with hepatocellular carcinoma (HCC) who are receiving treatment with the combination of atezolizumab plus bevacizumab may be at risk of variceal bleeding, particularly those with a low platelet count, portal vein invasion, history of gastrointestinal bleeding, and varices needing treatment, as shown in a retrospective study.

For the study, researchers looked at 640 patients (mean age was 61.3 years, 82.5 percent male) with HCC who underwent endoscopy before undergoing atezolizumab–bevacizumab treatment at two hospitals in Korea. The aim was to assess the risk of variceal bleeding and determine its risk factors. Nonvariceal bleeding events were regarded as competing events.

Chronic hepatitis B virus was the main aetiology of HCC in the majority of the population (69.5 percent). Most patients had BCLC stage C disease (88.0 percent), and 48.9 percent had portal vein invasion.

Over a median follow-up of 5.6 months, variceal bleeding occurred in 7.0 percent of patients. The cumulative incidence of variceal bleeding was 6.3 percent at 6 months and 7.4 percent at 12 months. None of the patients who had variceal bleeding died.

Multivariable regression analysis showed that the risk of variceal bleeding increased in the presence of main portal vein invasion (subdistribution hazard ratio [SHR], 3.49, 95 percent confidence interval [CI], 1.63–7.44), low platelet count (SHR, 0.994, 95 percent CI, 0.99–1.00), a history of gastrointestinal bleeding (SHR, 3.70, 95 percent CI, 1.49–9.16), and varices needing treatment (SHR, 2.67, 95 percent CI, 1.26–5.64).

These findings may help clinicians in assessing and managing the risk of variceal bleeding in the present population in clinical settings, the researchers said.