Dataset Information

Impact of older age in patients receiving atezolizumab and bevacizumab for hepatocellular carcinoma.

ABSTRACT:

Background and aims

Combination atezolizumab/bevacizumab is the gold standard for first-line treatment of unresectable hepatocellular carcinoma (HCC). Our study investigated the efficacy and safety of combination therapy in older patients with HCC.

Methods

191 consecutive patients from eight centres receiving atezolizumab and bevacizumab were included. Overall survival (OS), progression-free survival (PFS), overall response rate (ORR) and disease control rate (DCR) defined by RECIST v1.1 were measured in older (age ≥ 65 years) and younger (age < 65 years) age patients. Treatment-related adverse events (trAEs) were evaluated.

Results

The elderly (n = 116) had higher rates of non-alcoholic fatty liver disease (19.8% vs. 2.7%; p < .001), presenting with smaller tumours (6.2 cm vs 7.9 cm, p = .02) with less portal vein thrombosis (31.9 vs. 54.7%, p = .002), with fewer patients presenting with BCLC-C stage disease (50.9 vs. 74.3%, p = .002). There was no significant difference in OS (median 14.9 vs. 15.1 months; HR 1.15, 95% CI 0.65-2.02 p = .63) and PFS (median 7.1 vs. 5.5 months; HR 1.11, 95% CI 0.54-1.92; p = .72) between older age and younger age. Older patients had similar ORR (27.6% vs. 20.0%; p = .27) and DCR (77.5% vs. 66.1%; p = .11) compared to younger patients. Atezolizumab-related (40.5% vs. 48.0%; p = .31) and bevacizumab-related (44.8% vs. 41.3%; p = .63) trAEs were comparable between groups. Rates of grade ≥3 trAEs and toxicity-related treatment discontinuation were similar between older and younger age patients. Patients 75 years and older had similar survival and safety outcomes compared to younger patients.

Conclusions

Atezolizumab and bevacizumab therapy is associated with comparable efficacy and tolerability in older age patients with unresectable HCC.

SUBMITTER: Vithayathil M

PROVIDER: S-EPMC9825835 | biostudies-literature | 2022 Nov

REPOSITORIES: biostudies-literature

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Publications

Impact of older age in patients receiving atezolizumab and bevacizumab for hepatocellular carcinoma.

Vithayathil Mathew M D'Alessio Antonio A Fulgenzi Claudia A M CAM Nishida Naoshi N Schönlein Martin M von Felden Johann J Schulze Kornelius K Wege Henning H Saeed Anwaar A Wietharn Brooke B Hildebrand Hannah H Wu Linda L Ang Celina C Marron Thomas U TU Weinmann Arndt A Galle Peter R PR Bettinger Dominik D Bengsch Bertram B Vogel Arndt A Balcar Lorenz L Scheiner Bernhard B Lee Pei-Chang PC Huang Yi-Hsiang YH Amara Suneetha S Muzaffar Mahvish M Naqash Abdul Rafeh AR Cammarota Antonella A Personeni Nicola N Pressiani Tiziana T Pinter Matthias M Cortellini Alessio A Kudo Masatoshi M Rimassa Lorenza L Pinato David J DJ Sharma Rohini R

Liver international : official journal of the International Association for the Study of the Liver 20220902 11

<h4>Background and aims</h4>Combination atezolizumab/bevacizumab is the gold standard for first-line treatment of unresectable hepatocellular carcinoma (HCC). Our study investigated the efficacy and safety of combination therapy in older patients with HCC.<h4>Methods</h4>191 consecutive patients from eight centres receiving atezolizumab and bevacizumab were included. Overall survival (OS), progression-free survival (PFS), overall response rate (ORR) and disease control rate (DCR) defined by RECI ...[more]

PMID: 35986902

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Project description:ImportanceAtezolizumab plus bevacizumab as a first-line therapy for patients with unresectable or metastatic hepatocellular carcinoma has been shown to improve overall and progression-free survival compared with standard sorafenib treatment. However, because of the high cost of atezolizumab plus bevacizumab, assessment of its value by considering both efficacy and cost is needed.ObjectiveTo evaluate the cost-effectiveness of atezolizumab plus bevacizumab vs sorafenib for patients with unresectable or metastatic hepatocellular carcinoma from a US payer perspective.Design, setting, and participantsThis economic evaluation was performed from June through September 2020, with a 6-year investment time period. Hypothetical patients were male and female adults 18 years or older who had a diagnosis of locally advanced metastatic or unresectable hepatocellular carcinoma confirmed by histologic or clinical features.Main outcomes and measuresHealth care costs (adjusted to 2020 US dollars), life-years, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER) of atezolizumab plus bevacizumab vs sorafenib were examined using a partitioned survival model. One-way deterministic and probabilistic sensitivity analyses were used to examine model uncertainty. The model was also used to estimate price reductions of atezolizumab plus bevacizumab that would achieve more favorable cost-effectiveness.ResultsIn the base case analysis of a hypothetical sample of 424 patients, atezolizumab plus bevacizumab was associated with an increase of 0.623 life-years (1.840 vs 1.218 life-years) and 0.484 QALYs (1.412 vs 0.928 QALYs) and with an incremental cost of $156 210 per patient compared with sorafenib. The ICER was $322 500 per QALY (5th to 95th percentile, $149 364-$683 744 per QALY), with 0.6% and 5.1% chance of being cost-effective at willingness-to-pay thresholds of $100 000 and $150 000 per QALY, respectively. The ICER never decreased below $150 000 per QALY in the 1-way sensitivity analyses. To achieve more favorable cost-effectiveness under the thresholds of $150 000 to $100 000 per QALY, the prices of atezolizumab and bevacizumab would need to be reduced by 37% to 47%.Conclusions and relevanceIn this economic evaluation, atezolizumab plus bevacizumab was associated with clinical benefit but was not cost-effective compared with sorafenib for first-line treatment of unresectable or metastatic hepatocellular carcinoma from a US payer perspective. A substantial reduction in price for atezolizumab plus bevacizumab would be needed to achieve favorable cost-effectiveness for this new therapy.

Dataset Information

Impact of older age in patients receiving atezolizumab and bevacizumab for hepatocellular carcinoma.

Background and aims

Methods

Results

Conclusions

Publications

Impact of older age in patients receiving atezolizumab and bevacizumab for hepatocellular carcinoma.

Similar Datasets

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