An Observational Study to Learn More About How Well a Treatment Works When Given After Treatment With Atezolizumab and Bevacizumab or Another Similar Combination of Drugs in Adults With Liver Cancer That Cannot be Treated With Surgery

Study Overview
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Brief Summary
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This is an observational study in which only data will be collected from adults with unresectable hepatocellular carcinoma. These adults should be prescribed a different treatment after treatment with atezolizumab and bevacizumab, or another similar combination of drugs, by their doctors. Unresectable hepatocellular carcinoma (uHCC) is a type of liver cancer that cannot be treated with surgery. In the past, sorafenib was the only approved first-line anti-cancer drug for people with uHCC. Regorafenib and other drugs were approved as second-line treatments for uHCC if a person could not take sorafenib or it stopped working for them. Lately, another first-line (1L) treatment called immuno-oncology (IO) immune checkpoint inhibitor combination (1L-IO combo), like atezolizumab with bevacizumab (AB), has become the preferred choice of treatment. This is because of the meaningful impact on patient survival. 1L-IO combo are drugs that help the body's defense system recognize and kill cancer cells. Since the other treatments were previously approved for use following sorafenib, the best order to take these treatments in following an 1L-IO combo is unknown. To better understand and determine this order, more knowledge is needed about how well different treatments work in participants with uHCC who have been treated with AB or another 1L-IO combo. The main purpose of this study is to learn more about how well different treatments work when given after first-line treatment with AB or another approved 1L-IO combo. To do this, researchers will collect data on how long the participants live (also called overall survival) from the start of any treatment given after the first-line treatment. In addition, researchers will also collect the following information to learn more about the participants who will be given a different treatment after the 1L-IO combo: characteristics including age, sex, and race, and signs and symptoms of the participants over the duration of their first-line treatment the length of time from the first to the last dose (also called duration of therapy) of the treatments given after the 1L-IO combo the length of time until a participant's cancer worsens, or they die (also called progression free survival) from the start of the treatments given after the 1L-IO combo the number of participants whose tumor completely disappears or shrinks (also called overall tumor response) after taking the treatments given after the 1L-IO combo the sequence of treatments given after the 1L-IO combo Data will be collected from September 2023 to December 2026 and cover a period of around 3 years. The data will be collected using medical records or by interviewing the participants during their routine visits to the doctor. Researchers will observe participants from the start of the treatment given after the 1L-IO combo until the end of their participation in the study. In this study, only data from routine care will be collected. No visits or tests are required as part of this study.

Official Title
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An Observational Study in Patients With Unresectable Hepatocellular Carcinoma (uHCC) Following Treatment With Atezolizumab Plus Bevacizumab (AB) or With Another Approved Immuno-oncology Immune Checkpoint Inhibitor Combination in First-line

Conditions
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Unresectable Hepatocellular Carcinoma

Intervention / Treatment
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* Drug: Atezolizumab
* Drug: Bevacizumab
* Drug: Durvalumab
* Drug: Tremelimumab,


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adult patients, ≥ 18 years of age on the day of signing informed consent. Confirmed diagnosis of uHCC, treated in a first-line setting with AB or another approved 1L-IO combo therapy. Decision to initiate treatment with a second-line systemic treatment was made as per investigator's routine treatment practice prior to study enrollment. Signed informed consent or (for patients under legal age) signed informed assent by the patient (where applicable) and signed informed consent by parents / legal guardian. No participation in an investigational program with interventions outside of routine clinical practice. Exclusion Criteria: - Not applicable

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Treatment<br>Patients with a diagnosis of uHCC treated with first-line AB or another approved 1L-IO combo and in whom a decision to treat with a second-line of systemic therapy has been made by the treating physician at the time of study enrollment | Drug: Atezolizumab<br>* Atezolizumab combined with Bevacizumab, immune checkpoint inhibitors combination.<br>Drug: Bevacizumab<br>* Atezolizumab combined with Bevacizumab, immune checkpoint inhibitors combination.<br>Drug: Durvalumab<br>* Durvalumab combined with Tremelimumab, another immuno-oncology (IO) checkpoint inhibitors combination.<br>Drug: Tremelimumab,<br>* Durvalumab combined with Tremelimumab, another immuno-oncology (IO) checkpoint inhibitors combination.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Overall survival (OS) | OS is defined as the time (days) from start of second-line systemic treatment to the date of death, due to any cause. Patients alive or lost to follow-up will be censored at their last date of follow-up. | Approximately 36 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Discriptive analysis of demographic characteristics |  | At baseline before the first drug administration of second-line systemic treatment | 
| Discriptive analysis of clinical characteristics |  | At baseline before the first drug administration of second-line systemic treatment | 
| Duration of therapy (DoT) | DoT in second-line setting will be calculated as the time (days) from the date of initiation of the second -line systemic treatment to the stop of this treatment regimen or to last date of follow-up, if treatment was ongoing on that date. | Approximately 36 months | 
| Progression-free survival (PFS) | PFS is defined as the time (days) from the date of initiation of systemic treatment to the earliest date of first observed disease progression (radiological or clinical) or death due to any cause. | Approximately 36 months | 
| Best overall response rate (ORR) | ORR will be defined according to investigator-assessed data according to local standard. | Approximately 36 months | 
| Treatment sequences post first-line AB or other IO combinations |  | Approximately 36 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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uHCC, systemic treatment, real-world data, prospective