DOI: 10.25934/pr00008175
title: Efficacy and safety of atezolizumab plus bevacizumab for patients with advanced hepatocellular carcinoma based on albumin-bilirubin grade

description: Hepatocellular carcinoma (HCC) is the fifth most common type of primary liver cancer with approximately 700,000 deaths of HCC per year worldwide, and ranks as the second and sixth leading cause of cancer death in males and females, respectively. It is well known that the condition of the liver, the quality and quantity of cells, has a substantial influence on the prognosis of HCC patients. The Child-Pugh (C-P) classification has been widely used to assess liver dysfunction. The C-P includes objective measures like albumin and bilirubin levels in the blood, as well as more subjective measures which rely on clinicians' evaluations. As generally known, albumin is a protein that helps move many small molecules through the blood, including bilirubin. Bilirubin is a yellow substance made during the normal process when old blood cells are broken down and cleared by the liver. The albumin-bilirubin (ALBI) score based on albumin and bilirubin levels in the blood is a new model for assessing the severity of liver dysfunction, which is also a method of assessing liver failure. Most studies have demonstrated that ALBI grade is useful in guiding the treatment strategies including targeted therapy (cabozantinib, bevacizumab), immunotherapy (ipilimumab, nivolumab, pembrolizumab, atezolizumab), the destruction of cancer tissues by extreme temperatures and radiation therapy in HCC patients who were considered unresectable (where the tumor is not capable of being surgically removed). In this setting, the tumor can no longer be removed through surgery either because they already have advanced-stage HCC, or because there would be insufficient liver after surgery to carry out its functions (<40% for patients with scarring of the liver caused by long-term liver damage; <30% for patients without scarring of the liver caused by long-term liver damage) or intolerable surgical trauma. IMbrave150 is a global, open-label, randomised, phase 3 trial to evaluate the efficacy and safety of atezolizumab in combination with bevacizumab compared with sorafenib in patients with untreated locally advanced or metastatic (where the cancer has spread to other areas of the body) hepatocellular carcinoma. The study demonstrated better outcomes for patients treated with atezolizumab plus bevacizumab. Given the impressive result of IMbrave150, atezolizumab plus bevacizumab therapy is the only cancer immunotherapy regimen currently approved by the FDA for the first-line treatment of unresectable or metastatic hepatocellular carcinoma. However, the superiority of atezolizumab plus bevacizumab in patients with different ALBI grades remains inconclusive. This study will provide new opinion based on ALBI grade when employing atezolizumab plus bevacizumab therapy, and will propose the consideration of ALBI grade-based subgroup analysis in future randomised control trials. A post-hoc analysis using the accessed data from IMbrave150 study will be performed to evaluate efficacy and safety of atezolizumab plus bevacizumab therapy compared to sorafenib monotherapy in HCC stratified by different ALBI grades.