DOI: 10.1002/cam4.7025 ISSN: 2045-7634

Efficacy and safety of atezolizumab plus bevacizumab in patients with portal hypertension for unresectable hepatocellular carcinoma

Takahiro Kinami, Shinsuke Uchikawa, Tomokazu Kawaoka, Shintaro Yamasaki, Masanari Kosaka, Yusuke Johira, Shigeki Yano, Kei Amioka, Kensuke Naruto, Kenji Yamaoka, Yasutoshi Fujii, Hatsue Fujino, Takashi Nakahara, Atsushi Ono, Eisuke Murakami, Wataru Okamoto, Masami Yamauchi, Daiki Miki, Masataka Tsuge, Shiro Oka
  • Cancer Research
  • Radiology, Nuclear Medicine and imaging
  • Oncology



Atezolizumab plus bevacizumab combination therapy (Atezo + Beva) is used as the first‐line therapy for unresectable hepatocellular carcinoma (u‐HCC). Serious adverse events (AEs), including rupture of esophagogastric varices, have been seen during treatment. Therefore, the relationships of efficacy, safety, and portal hypertension (PH) were analyzed.


A total of 146 patients with u‐HCC and Child‐Pugh Scores of 5–7 received Atezo + Beva. Prophylactic treatment for varices was performed for patients with the risk of rupture of varices before the start of Atezo + Beva. A propensity score‐matched cohort was created to minimize the risk of potential confounders. Efficacy was assessed in 41 propensity score‐matched pairs. AEs were assessed between patients without PH (n = 80) and with PH (n = 66).


In patients without PH and with PH, median overall survival was 18.4 months and 18.8 months (p = 0.71), and median progression‐free survival was 8.6 months and 5.8 months (p = 0.92), respectively. On the best radiological response evaluation for Response Evaluation Criteria in Solid Tumors, the objective response rate was 31.7% and 26.8% (p = 0.81), respectively. Variceal rupture occurred in three patients with PH, but there were no significant differences in the occurrence of variceal rupture (p = 0.090) and Grade 3–4 AEs between patients without and with PH.


No significant differences in efficacy and safety were observed with PH. Prophylactic treatment for varices before the start of Atezo + Beva would allow treatment to continue relatively safely.

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