Real-world data: Clinical characteristics and outcomes of patients with advanced hepatocellular carcinoma treated with atezolizumab plus bevacizumab in Veteran Health Administration.

person Munaf Alkadimi University of Texas Health Science Center at San Antonio, San Anonio, TX info_outline Munaf Alkadimi, Kana Lucero, Lauren Diaz Boyle, Maria Elena Fierro, Kathleen Franklin, Zohra Nooruddin, Michael Mader

Authors person Munaf Alkadimi University of Texas Health Science Center at San Antonio, San Anonio, TX info_outline Munaf Alkadimi, Kana Lucero, Lauren Diaz Boyle, Maria Elena Fierro, Kathleen Franklin, Zohra Nooruddin, Michael Mader Organizations University of Texas Health Science Center at San Antonio, San Anonio, TX, University of Texas Health Science Center at San Antonio, San Antonio, TX, The University of Texas Health Science Center-San Antonio, San Antonio, TX, South Texas Veterans Health Care System, San Antonio, TX, University of Texas Health San Antonio, San Antonio, TX Abstract Disclosures Research Funding No funding received None. Background: Advanced Hepatocellular carcinoma (HCC) is an aggressive tumor, and most patients have a poor prognosis. Recent clinical trials have demonstrated improved survival with molecularly targeted treatment and immunotherapy. Atezolizumab plus Bevacizumab (A+B ) is the recommended first-line treatment for advanced HCC based on the phase 3 IMbrave 150 trial. However, in a real-life setting, many patients do not meet the inclusion criteria of this landmark trial. This study proposes a retrospective review of outcomes of advanced HCC patients receiving A + B in Veterans Health Administration (VHA). Methods: Patients with advanced HCC receiving 1st line systemic therapy with A+ B at the VHA between Dec 1, 2019, to Mar 1, 2022, were selected from the electronic medical records (EMR) using ICD-9 and ICD-10 codes. Abstractors reviewed EMR and followed from their index date of A+ B initiation until death or their last VHA visit, with the study period ending on Jan 31, 2023. The Chi-Squared test was used to compare rates, and the Mann-Whitney test was used to compare medians. Results: A total of 332 patients met the study criteria. The median age was 67 yrs., 99% were males, 63% non-Hispanic White, 26% were Black, 66 % had ECOG ≥ 1, 84% had CPS class A, 16% had CPS class B and C, 62% had grade 2 ALBI score, 56% had viral hepatitis-caused HCC, 80 % had cirrhosis, and 67% had prior local therapies. The outcomes are shown. Conclusions: In our real world, despite having similar PFS as the phase 3 IMbrave 150 trial, our OS at 12 months was lower (52% vs. 67%), given that we had more elderly patients with moderate liver dysfunction and 40% were non-white. This study provides actual outcomes in clinical practice where patients do not match the study population of the pivotal trial. End points for VA HCC patients given AB as 1st line. Characteristic of Interest All Patients N (≥ 6 mo from initiation to abstraction) N(≥ 12 mo from initiation to abstraction) 332 304 Number of A + B doses, median (IQR) Range: (min, max) 6 (3 – 13) (1, 34) Overall Survival Time, months 11.4 (5.4 – 18.7) OS: 6 mo OS: 1 yr 243 (73.2%) 158 (52.0%) Response to AB at first scan: CR PR SD PD Death Objective Response Rate(CR+PR) Disease Control Rate(CR+PR+SD) 5 ( 1.6%) 91 (28.4%) 100 (31.3%) 82 (25.6%) 42 (13.1%) 96 (30.0%) 196 (61.3%) Progression-Free Survival, months 7.6 (3.0 – 14.9) PFS: 6 mo PFS: 1 yr 187 (58.8%) 105 (36.3%) Duration of Response (CR,PR,SD), months 9.8 (4.9 – 15.6)