Atezolizumab-bevacizumab combo maintains QoL in liver cancer patients

The combination of the PD-L1* inhibitor atezolizumab and the VEGF** inhibitor bevacizumab generated substantial and consistent benefits in terms of quality of life (QoL) compared with standard-of-care sorafenib in patients with unresectable hepatocellular carcinoma (HCC) who have not received prior systemic therapy, according to the patient-reported outcomes (PROs) from the IMbrave150*** trial presented at ASCO GI 2020.

“[As] it reflects both the effects of disease and the side effects of treatment, sustained or improved QoL is particularly important for patients,” said study author Dr Peter Galle from the University Medical Center in Mainz, Germany in a press release. “Patients with liver cancer are typically more fragile and frailer than [other cancer patients]. Toxicity of the treatments can be much more serious for these patients, and their QoL can decline quite quickly,” he continued.

The IMbrave150 team compared the combination regimen consisting of intravenous (IV) atezolizumab 1,200 mg Q3W + IV bevacizumab 15 mg/kg Q3W against sorafenib 400 mg twice daily. A total of 501 individuals (median age 65 years, 83 percent male) were randomized at a 2:1 ratio to receive either regimen until loss of clinical benefit or unacceptable toxicity. Participants completed two questionnaires^# before treatment, every 3 weeks during treatment, and every 3 months following treatment cessation or disease progression. [ASCO GI 2020, abstract 476]

Compared with sorafenib, atezolizumab + bevacizumab delayed the median time-to-deterioration (TTD) of patient-reported QoL (11.2 vs 3.6 months; hazard ratio [HR], 0.63, 95 percent confidence interval [CI], 0.46–0.85), physical functioning (13.1 vs 4.9 months; HR, 0.53, 95 percent CI, 0.39–0.73), and role functioning (9.1 vs 3.6 months; HR, 0.62, 95 percent CI, 0.46–0.84).

Atezolizumab + bevacizumab also delayed TTD in patient-reported pain, fatigue, diarrhoea, and loss of appetite vs sorafenib. A fraction of the combination regimen recipients experienced clinically meaningful deterioration in each of these symptoms, noted the researchers.

Taken together, these outcomes support the overall clinical benefit of the atezolizumab-bevacizumab combination regimen reported in the initial results of this phase III trial, said the researchers.

“PROs are now recognized as important endpoints of cancer clinical trials,” underscored ASCO Chief Medical Officer and Executive Vice President Dr Richard Schilsky. “[PROs] provide important insights regarding the impact of treatment on QoL. PROs inform us about the tolerability of new therapies, which is just as important as efficacy in gauging their utility and acceptance by patients … [and may] have prognostic value for cancer patients.”