The Efficacy and Safety of Atezolizumab Plus Bevacizumab after Durvalumab Plus Tremelimumab for the Treatment of Hepatocellular Carcinoma

Objective This study aimed to evaluate the efficacy and safety of atezolizumab plus bevacizumab (Atez+Bev) as a second-line therapy after the administration of durvalumab plus tremelimumab (Dur+Tre) in patients with hepatocellular carcinoma (HCC). We focused on the treatment outcomes and adverse event profiles specific to this sequential regimen. Methods A retrospective analysis was conducted on 16 patients who received second-line Atez+Bev after Dur+Tre therapy between April 2023 and August 2024 in our hospital and associated institutions. The objective response rate (ORR), disease control rate (DCR), treatment duration, and adverse events were assessed. Results The ORR and DCR for second-line Atez+Bev were 25.0% and 75.0%, respectively, thus suggesting favorable disease control. Even among patients who were non-responsive to Dur+Tre, two achieved a tumor response and eight achieved disease control. Regarding safety, pruritus was a common adverse event for both regimens. Colitis and diarrhea were more frequent in the Dur+Tre group, whereas proteinuria, hyperammonemia, and bleeding were more common in the Atez+Bev group. Conclusions This study suggests that Atez+Bev remains a viable option for patients unresponsive to Dur+Tre. Prior Dur+Tre therapy may enhance the immune response within the tumor microenvironment, thereby augmenting the efficacy of Atez+Bev. However, it is important to pay attention to the differences in adverse effect profiles between the two regimens.