Response-survival Association Differs by Hepatic Reserve in Unresectable HCC Receiving Atezolizumab Plus Bevacizumab

Evidence supporting atezolizumab plus bevacizumab (Atez/Bev) for unresectable hepatocellular carcinoma (uHCC) in patients with Child-Pugh B (CP-B) liver function is limited. We investigated whether the prognostic significance of radiologic response differs according to hepatic reserve and evaluated the impact of baseline neutrophil-to-lymphocyte ratio (NLR).

We retrospectively analyzed 105 consecutive patients with uHCC treated with Atez/Bev (CP-A, n=82; CP-B, n=23). Tumor response was assessed by modified RECIST, and overall survival (OS) was estimated using Kaplan-Meier methods. Baseline NLR was evaluated using a prespecified cut-off of 2.56.

Response was not evaluable more often in CP-B than in CP-A (21.7% vs. 4.8%). In CP-A, objective response and disease control were each associated with longer OS (p=0.002 and p=0.003, respectively). In CP-B, neither objective response nor disease control was significantly associated with OS; OS was similar for stable disease and objective response (10.6 vs. 10.7 months). Across the cohort, NLR <2.56 was associated with longer OS and remained prognostic in both CP-A and CP-B.

The prognostic meaning of radiologic response differed according to hepatic reserve. While objective response is strongly associated with survival in CP-A, disease stabilization may represent clinically meaningful benefit in CP-B. Baseline NLR may aid risk stratification in CP-B uHCC treated with Atez/Bev.