@article{b86131cb9c044d9c83e689329f56b2f0,
title = "Outcomes and Toxicities of Modern Combined Modality Therapy with Atezolizumab Plus Bevacizumab and Radiation Therapy for Hepatocellular Carcinoma",
abstract = "Atezolizumab plus bevacizumab has become frontline therapy for unresectable HCC. The compatibility of atezolizumab/bevacizumab with liver-directed RT has not been reported. Methods: HCC patients treated with liver-directed RT and atezolizumab/bevacizumab between 1/2020–11/2021 were included. Toxicity and outcomes were retrospectively recorded. For ALCs, we matched the analysis to a previously cohort of RT-treated HCC patients who did not receive atezolizumab/bevacizumab. Survival and time-to-liver-failure were analyzed using Kaplan–Meier. Results: Of 21 patients, with a median follow-up of 9.5 months, the median OS was 16.1 months. Post-RT, all patients had reduced tumors or treatment response. There were no ≥Grade 3 RT-related toxicities. Autoimmune complications occurred in two patients (9.5%), and GI bleeding in three patients (14.3%). Liver function remained stable post-RT. There was a marked decrease in ALCs immediately post-RT (post-RT/pre-RT ratio 47.3%, p < 0.0001), restored by 1 month to pre-treatment baseline (1-month post-RT/pre-RT ratio 95.1%, n.s.). Compared to HCC patients treated with RT alone, post-RT ALC recovery was faster with atezolizumab/bevacizumab (p = 0.009). Conclusion: In this first reported experience of RT with modern systemic therapy for HCC, combination therapy is safe and well-tolerated. As a favorable prognosticator, there appears to be faster recovery of ALC among patients who received RT with atezolizumab/bevacizumab.",
keywords = "RT, atezolizumab, bevacizumab, hepatocellular carcinoma, immunotherapy, radiation therapy",
author = "Manzar, {Gohar Shahwar} and De, {Brian Sandeep} and Abana, {Chike Osita} and Lee, {Sunyoung S.} and Milind Javle and Kaseb, {Ahmed O.} and Vauthey, {Jean Nicolas} and Cao, {Hop Sanderson Tran} and Koong, {Albert C.} and Smith, {Grace Li} and Taniguchi, {Cullen M.} and Holliday, {Emma Brey} and Prajnan Das and Koay, {Eugene Jon} and Ludmir, {Ethan Bernard}",
note = "Funding Information: This work was supported by Cancer Center Support (Core) grant P30 CA016672 from the National Cancer Institute, National Institutes of Health, to The University of Texas MD Anderson Cancer Center. EJK was supported by DOD (W81 XWH-21-1-0709) and NIH (U54 CA210181, U54 CA143837, U01 CA196403, U01 CA200468, U01 CA200468, U01 CA214263, P50 CA221707, R01 CA221971, R01 CA218004, P30 CA016672). EBL was supported by the Andrew Sabin Family Fellowship and the Fund for Innovation in Cancer Informatics. BD was supported by the RSNA Research & Education Foundation through grant number RR2111. Funding Information: Conflicts of Interest: All reported conflicts are outside the submitted work. GSM reports a patent for induced pluripotent stem cell-derived pancreatic beta cells and previous grants from ReproCell, Inc. and the AAI. BD reports consulting honoraria from Sermo, Inc. EBH reports research funding from Merck Serono. CMT reports a consulting/advisory role with Accuray. EJK reports grants from National Institutes of Health, Stand Up 2 Cancer, MD Anderson Cancer Center, Philips Healthcare, Elekta, and GE Healthcare; personal fees from RenovoRx and Taylor and Francis; a consulting role with AstraZeneca; and a consulting/advisory role with Augmenix. ACK reports ownership of shares in Aravive, Inc. PD reports consulting/advisory relationships with the American Society for Radiation Oncology and the National Cancer Institute. Publisher Copyright: {\textcopyright} 2022 by the authors. Licensee MDPI, Basel, Switzerland.",
year = "2022",
month = apr,
day = "9",
doi = "10.3390/cancers14081901",
language = "English (US)",
volume = "14",
journal = "Cancers",
issn = "2072-6694",
publisher = "Multidisciplinary Digital Publishing Institute (MDPI)",
number = "8",
}