Efficacy and safety of atezolizumab plus bevacizumab treatment for unresectable hepatocellular carcinoma patients with esophageal–gastric varices

• Published in: Journal of gastroenterology 2023-11, Vol.58 (11), p.1134-1143
• Main Authors: Tada, Fujimasa, Hiraoka, Atsushi, Tada, Toshifumi, Hirooka, Masashi, Kariyama, Kazuya, Tani, Joji, Atsukawa, Masanori, Takaguchi, Koichi, Itobayashi, Ei, Fukunishi, Shinya, Tsuji, Kunihiko, Ishikawa, Toru, Tajiri, Kazuto, Ochi, Hironori, Toyoda, Hidenori, Ogawa, Chikara, Nishimura, Takashi, Hatanaka, Takeshi, Kakizaki, Satoru, Shimada, Noritomo, Kawata, Kazuhito, Naganuma, Atsushi, Kosaka, Hisashi, Matono, Tomomitsu, Kuroda, Hidekatsu, Yata, Yutaka, Ohama, Hideko, Nouso, Kazuhiro, Morishita, Asahiro, Tsutsui, Akemi, Nagano, Takuya, Itokawa, Norio, Okubo, Tomomi, Arai, Taeang, Yokohama, Keisuke, Nishikawa, Hiroki, Imai, Michitaka, Koizumi, Yohei, Nakamura, Shinichiro, Iijima, Hiroko, Kaibori, Masaki, Hiasa, Yoichi, Kumada, Takashi
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Antimitotic agents; Antineoplastic agents; Bevacizumab; Biliary Tract; Blood clot; Colorectal Surgery; Development and progression; Diarrhea; Drug therapy; Endoscopy; Esophageal cancer; Esophageal carcinoma; Esophagus; Gastric cancer; Gastroenterology; Glycoproteins; Health aspects; Hemorrhage; Hepatocellular carcinoma; Hepatology; Hepatoma; Liver cancer; Medical colleges; Medical prognosis; Medicine; Medicine & Public Health; Metastases; Original Article―Liver; Pancreas; Portal vein; Surgical Oncology; Thrombosis; Varicose veins; Vascular endothelial growth factor; α-Fetoprotein
• ISSN: 0944-1174; 1435-5922
• DOI: 10.1007/s00535-023-02026-2

Background Bevacizumab inhibits vascular endothelial growth factor-A (VEGF-A), though is known to increase bleeding risk as an adverse event (AE). This study examined whether atezolizumab/bevacizumab (Atez/Bev) for unresectable hepatocellular carcinoma (uHCC) can be used for patients with esophageal–gastric varices (EGV). Methods From October 2020 to December 2022, 506 uHCC patients (median 74 years) underwent an upper gastrointestinal endoscopy examination were enrolled, after exclusion of those with portal vein tumor thrombus (PVTT). Patients with EGV (≧ F1) were defined as EGV positive, and the cohort was divided into non-EGV ( n  = 355) and EGV ( n  = 151). Before introducing Atez/Bev, endoscopic treatment was performed, when necessary. Prognosis was evaluated, retrospectively. Results The EGV group had significantly worse hepatic function, lower platelet count, elevated alpha-fetoprotein, and lower rate of extrahepatic metastasis, and lower rate of first-line use (each P