Liver international : official journal of the International Association for the Study of the Liver · 2025
Hepatitis C Eradication Improves Oncologic and Clinical Outcomes in Patients Treated With Atezolizumab Plus Bevacizumab.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Stella Leonardo, Cabibbo Giuseppe, Celsa Ciro, Ciccia Roberta, Sparacino Alba, Piscaglia Fabio, Tovoli Francesco, Arleo Andrea, Stefanini Bernardo, Iavarone Massimo, D'Ambrosio Roberta, Cerrito Lucia, Pallozzi Maria, Santopaolo Francesco, Marra Fabio, Campani Claudia, Mazzarelli Chiara, Viganò Raffaella, Tortora Raffaella, Aghemo Alessio, Nicola Stella De, Pressiani Tiziana, Rimassa Lorenza, Bhoori Sherrie, Corallo Salvatore, Maiocchi Laura, Martini Andrea, Soldà Caterina, Russo Francesco Paolo, Gasbarrini Antonio, Ponziani Francesca Romana
Аннотация
BACKGROUND AND AIMS: Hepatitis C virus (HCV) is a key driver of hepatocellular carcinoma (HCC). However, the impact of HCV eradication on systemic therapy remains unclear. We aimed to assess the safety and efficacy of direct-acting antivirals (DAA) in patients treated with Atezolizumab plus Bevacizumab (AtezoBev).
METHODS: This retrospective multicentre study included patients with HCV-related unresectable/advanced HCC treated with AtezoBev between 2021 and 2024. Three groups of patients were compared: Group A (n = 22), concurrent DAA with AtezoBev; Group B (n = 95), antiviral therapy before AtezoBev; and Group C (n = 22), active infection.
RESULTS: Group A showed the longest median overall survival (42.8 months) compared to Group B (26.8 months; p = 0.03) and Group C (19.7 months; p = 0.01). Time to progression and progression-free survival were significantly prolonged in Group A versus Groups B and C. Moreover, Group A exhibited a higher disease control rate than the other groups. Post-DAA decompensation rates were significantly lower in Group A (4.5%) compared to Groups B (26.3%) and C (36.4%). Treatment-related adverse events of grade ≥ 3 were similar across groups. In the multivariate competing risk analysis with adjustment for time-dependent variables, achieving sustained virologic response during AtezoBev showed a protective effect against liver decompensation (sHR 0.02, p = 0.003) or tumour progression (sHR 0.14, p = 0.009), and was also associated with reduced mortality (HR 0.29, p = 0.005).
CONCLUSIONS: Achieving a SVR during AtezoBev seems to improve oncologic outcomes and reduce liver decompensation in patients with unresectable/advanced HCC. An integrated therapeutic approach can optimise systemic treatment efficacy, particularly in patients eligible for conversion strategies.
TRIAL REGISTRATION: Protocol ID: 5890.
METHODS: This retrospective multicentre study included patients with HCV-related unresectable/advanced HCC treated with AtezoBev between 2021 and 2024. Three groups of patients were compared: Group A (n = 22), concurrent DAA with AtezoBev; Group B (n = 95), antiviral therapy before AtezoBev; and Group C (n = 22), active infection.
RESULTS: Group A showed the longest median overall survival (42.8 months) compared to Group B (26.8 months; p = 0.03) and Group C (19.7 months; p = 0.01). Time to progression and progression-free survival were significantly prolonged in Group A versus Groups B and C. Moreover, Group A exhibited a higher disease control rate than the other groups. Post-DAA decompensation rates were significantly lower in Group A (4.5%) compared to Groups B (26.3%) and C (36.4%). Treatment-related adverse events of grade ≥ 3 were similar across groups. In the multivariate competing risk analysis with adjustment for time-dependent variables, achieving sustained virologic response during AtezoBev showed a protective effect against liver decompensation (sHR 0.02, p = 0.003) or tumour progression (sHR 0.14, p = 0.009), and was also associated with reduced mortality (HR 0.29, p = 0.005).
CONCLUSIONS: Achieving a SVR during AtezoBev seems to improve oncologic outcomes and reduce liver decompensation in patients with unresectable/advanced HCC. An integrated therapeutic approach can optimise systemic treatment efficacy, particularly in patients eligible for conversion strategies.
TRIAL REGISTRATION: Protocol ID: 5890.