Comparison analysis of different doses bevacizumab plus ICIs and interventional therapy in unresectable...

Bevacizumab, immune checkpoint inhibitors (ICIs), interventional therapy, either alone or in combination, have demonstrated promising anti-tumor activities in unresectable hepatocellular carcinoma (HCC). However, the optimal dosing strategy for bevacizumab within combination regimens remains undetermined. This study aimed to compare the efficacy and safety of different bevacizumab doses in triple therapy combining bevacizumab, ICIs, and interventional therapy for unresectable HCC.

A retrospective study included patients with unresectable HCC treated with interventional therapy combined with bevacizumab (full dose or half dose) and ICIs between December 2020 and July 2023 was conducted. Propensity score matching (PSM, 1:1) was applied to minimize confounding effects. The progression-free survival (PFS), overall survival (OS), objective response rate (ORR), and disease control rate (DCR) were compared and evaluated. Treatment-related adverse events (AEs) were analyzed to assess safety.

Among 66 enrolled patients, 36 received full-dose bevacizumab, and 30 received half-dose bevacizumab. The full-dose group exhibited significantly longer PFS compared to the half-dose group (median PFS: not attained vs. 8.0 months, P<0.001). Median OS was not reached in either group, with 1-year OS rate of 86% in the full-dose group and 83% in the half-dose group. Although full-dose group showed numerically higher ORR (55.6% vs. 36.7%, P=0.13) and DCR (88.9% vs. 83.3%, P=0.51), these differences did not reach statistical significance. Half-dose group experienced comparable AEs with full-dose group. Post-PSM analyses corroborated these findings.

Although full-dose bevacizumab in triple therapy showed prolonged PFS compared to half-dose group, no statistically significant differences were observed in long-term survival outcomes or treatment-related AEs between the two groups. For unresectable HCC patients with severe liver cirrhosis, half-dose bevacizumab may serve as a safer alternative without compromising survival benefits.