Real-world outcomes of atezolizumab plus bevacizumab in patients with unresectable hepatocellular carcinoma: A retrospective study from King Fahad Medical City, Saudi Arabia.

Abstract

492 Background: Hepatocellular carcinoma (HCC) is a significant health burden in Saudi Arabia, commonly diagnosed at intermediate (BCLC B) or advanced (BCLC C) stages. The IMbrave150 trial established the combination of Atezolizumab (anti-PD-L1) and Bevacizumab (anti-VEGF) as the standard first-line therapy for unresectable HCC, showing improved survival over sorafenib. However, real-world data on this therapy's effectiveness and safety, especially in the Saudi Arabian population, is limited. Methods: This retrospective cohort study analyzed HCC patients treated with atezolizumab-bevacizumab at King Fahad Medical City, Riyadh from January 2021 to December 2024. The study included 47 patients with confirmed unresectable HCC (BCLC B or C) who had adequate liver function and no prior systemic therapy. We evaluated real-world overall survival (OS) and treatment-related adverse events (TRAEs). Results: The median age of patients was 68 years (range 38–90), with 70% (n=33) being male. Most patients had multiple comorbidities (93%, n=44) and cirrhosis (83%, n=39), with viral hepatitis being the most common cause (53%, n=25). A majority of patients (87%, n=41) were classified as BCLC Stage C, with 45% (n=21) having portal vein thrombosis. Most patients (87%, n=41) had a good performance status (ECOG 0 or 1), and 77% (n=36) were Child-Pugh class A, while 23% (n=11) were class B. The median number of treatment cycles was 5 (range 1–22). Treatment-related toxicity was manageable, with one case of bleeding and three cases of immune-mediated toxicity reported required treatment discontinuation. Around 21% (n=10) of patients experienced decompensated cirrhosis while on treatment. A significant number of patients (68%, n=32) did not receive second-line therapy. Seventeen patients (36%) were lost to follow-up, so only 30 patients were included for survival analysis. With a median follow-up of 9.5 months (range 1–48 months), the Kaplan-Meier method showed a median survival of 13.6 months (95% CI 4.9–21.08). The one-year survival rate was 41%. Conclusions: Our findings demonstrate a lower survival rate than that reported in the IMbrave150 trial, which may be due to our smaller number of patients and the characteristics of our cohort, which reflects a real-world patient population. Our study showed a manageable safety profile in a predominantly cirrhotic population. This data will help guide clinical practice in Saudi Arabia and contribute to the global real-world data on HCC management.