Comparing the bleeding risk in hepatocellular carcinoma patients treated with atezolizumab/bevacizumab versus durvalumab plus tremelimumab.

Abstract

e13882 Background: This study compares bleeding risk in hepatocellular carcinoma (HCC) patients receiving Atezolizumab/Bevacizumab (A+B) vs. Durvalumab/Tremelimumab (D+T). Methods: A retrospective cohort analysis using the TriNetX Research Network (104 healthcare organizations) examined matched cohorts: A+B (n = 69) and D+T (n = 69). Patients had INR > 1.8 and platelet count < 50,000. Outcomes included gastrointestinal (GI) bleeding, variceal bleeding, and other hemorrhagic events. Results: GI bleeding incidence was similar (A+B: 15.9%, D+T: 14.5%; p = 0.813), as was variceal bleeding (14.5% in both; p = 0.998). Conclusions: GI and variceal bleeding risks were comparable. Personalized risk assessment is essential, and further studies are needed. Propensity matching of baseline characteristics. Baseline Characteristics Before propensity matching After propensity matching A + B (INR>1.8 +- PLT< 50k) (N=312) D + T (INR>1.8 +- PLT< 50k) (N=71) P value A + B (INR>1.8 +- PLT< 50k) (N=69) D + T (INR>1.8 +- PLT< 50k) (N=69) P value Characteristics: Age, y, mean ± SD 67.3 +/- 9.6 65.2 +/- 10.1 0.104 66.3 +/- 9.7; 69 (100) 65.3 +/- 10.2; 69 (100) 0.539 Male, n(%) 237 (76) 55 (77.5) 0.78 50 (72.5) 53 (76.8) 0.56 Female, n (%) 65 (20.8) 14 (19.7) 0.83 18 (26.1) 14 (20.3) 0.42 Race, n (%) White 179 (57.4) 40 (56.3) 0.87 39 (56.5) 40 (58.0) 0.86 Black or African American 31 (9.9) 10 (14.1) 0.31 10 (14.5) 10 (14.5) <0.001 Asian 30 (9.6) 12 (16.9) 0.08 15 (21.7) 11 (15.9) 0.38 Unknown Race 39 (12.5) 10 (14.1) 0.72 10 (14.5) 10 (14.5) <0.001 Comorbid Conditions: HTN 200 (64.1) 50 (70.4) 0.313 49 (71) 49 (71) <0.001 Fibrosis and cirrhosis of liver 227 (72.8) 59 (83.1) 0.071 57 (82.6) 58 (84.1) 0.82 Diabetes mellitus 128 (41.0) 31 (43.7) 0.68 35 (50.7) 30 (43.5) 0.39 Laboratory: Hemoglobin [Mass/volume] in Blood 11.6 +/- 2.4; 299 (95.8) 11.5 +/- 2.1; 69 (97.2) 0.626 11.9 +/- 2.4; 69 (100) 11.4 +/- 2.1; 68 (99) 0.226 Platelets [#/volume] in Blood 139.7 +/- 109.5; 298(95.5) 115.4 +/- 86.9; 66 (93) 0.093 142.7 +/- 107.6; 69 (100) 115.8 +/- 87.8; 64 (92.8) 0.12 Alanine aminotransferase 78.4 +/- 135.7; 300 (96.2) 152.6 +/- 576.2; 70 (98.6) 0.045 54.9 +/- 55.3; 69 (100) 87.8 +/- 204.3; 68 (98.6) 0.20 Aspartate aminotransferase 148.3 +/- 263.4; 299 (95.8) 570.6 +/- 3572.5; 70 (98.6) 0.043 110.7 +/- 136.3; 69 (100) 144.4 +/- 276.2 (98.6) 0.37 Alkaline phosphatase 246.6 +/- 192.4; 290 (92.9) 195 +/- 137.7; 69 (97.2) 0.036 235.7 +/- 157.2; 69 (100) 197.2 +/- 137.5; 68 (98.6) 0.13 Creatinine 1.2 +/- 1.0; 297 (95.2) 1.2 +/- 1.1; 68 (95.8) 0.021 1.0 +/- 0.5; 68 (98.6) 1.2 +/- 1.1; 67 (97.1) 0.06 Bilirubin.total 3.7 +/- 5.1; 297 (95.2) 3.7 +/- 4.5; 69 (97.2) 0.925 3.5 +/- 4.1; 69 (100) 3.7 +/- 4.5; 68 (98.6) 0.75 Odds Ratio 1.119 95% CI (0.442-2.836) p=0.813 Risk Ratio 1.100 95% CI (03500-2.421 p=0.813