Limited Prognostic Impact of Sustained Virologic Response on Atezolizumab plus Bevacizumab Therapy for HCV-Related Unresectable Hepatocellular Carcinoma

Authors:
Publisher website
Google Scholar
Abstract
Aims: Sustained virological response (SVR) is a favorable prognostic factor for patients with hepatocellular carcinoma (HCC) caused by hepatitis C virus (HCV) treated curatively. This study aimed to evaluate the impact of SVR on atezolizumab plus bevacizumab (Atez/Bev) therapy for unresectable HCC (uHCC) caused by HCV. Methods: A retrospective analysis of 364 uHCC patients treated with Atez/Bev (September 2020–April 2025) and divided into SVR (n = 284) and non-SVR (n = 80) groups was performed, with clinical characteristics, prognosis, and adverse events compared. Results: There were no significant differences between the groups for age, sex, platelet count, AFP, or BCLC stage. However, the SVR group showed a significantly better ALBI score (−2.50 vs. −2.16) and lower AST (33 vs. 57 IU/L) and ALT (23 vs. 40 IU/L) levels (p < 0.01). Median progression-free survival (PFS) was 7.1 months in the SVR group and 6.1 months in the non-SVR group (p = 0.443), and median overall survival (OS) was 20.9 months in the SVR group and 18.9 months in the non-SVR group, with no significant differences between the groups (p = 0.560). Following IPW adjustment for factors related to OS, there was no significant difference regarding PFS (p = 0.921) and OS (p = 0.927). Multivariate analysis identified age ≥75 years and poor hepatic function (mALBI grade 2b/3) as independent predictors of poor OS; SVR status was not an independent factor. Changes in ALBI and Child-Pugh scores over time were not significantly different between the groups. In the non-SVR group, adverse events were more common as compared to the SVR group, including liver dysfunction (27.5% vs. 13.0%, p < 0.001) and edema/ascites (12.5% vs. 9.2%, p = 0.015). Conclusions: Although SVR was not independently associated with better survival, patients with SVR had preserved liver function and experienced fewer adverse events. These factors may indirectly support improved tolerability and therapeutic options during Atez/Bev therapy for HCV-related uHCC.

This publication has 25 references indexed in Scilit: