Survival outcomes in patients (pts) with Child-Pugh class B (CP-B) liver function at progression after first-line atezolizumab-bevacizumab (Atezo-Bev) for unresectable hepatocellular carcinoma (uHCC): Asia-Pacific multicenter retrospective analysis.

553 Background: Worsening liver function is a major challenge in the management of uHCC. The optimal subsequent treatment strategy for patients with CP-B liver function at progression on first-line Atezo-Bev remains unclear. Methods: This multinational, multicenter retrospective study included pts with uHCC and CP-B liver function at progression on first-line Atezo-Bev from five institutions in Korea, Hong Kong, Taiwan, and Singapore between July 2016 and March 2025. For efficacy analyses of subsequent therapy, only pts with CP scores of 7 or 8 were included. Post-progression survival (PPS) was defined from the time of progression on Atezo-Bev to the death of any cause. Results: A total of 146 pts (median 64 year-old; 89% male, 11%) were included. At progression, CP scores were 7 (51%), 8 (34%), and 9 (15%). Of these, 84 pts (57.5%) received subsequent therapy; sorafenib in 42 (50%) and lenvatinib in 39 (46%), while 62 (43%) received best supportive care (BSC) only. Median PPS was 5.4, 2.3, and 2.5 mo in pts with CP score 7, 8, or 9, respectively (p<0.001). In pts with CP scores 7–8, those who received subsequent therapy had significantly longer PPS compared those with BSC (7.3 vs. 2.0 mo; HR 0.37, p<0.001). Among pts receiving second-line therapy, lenvatinib was significantly associated with longer PFS compared with sorafenib (3.5 vs 1.7 mo, p=0.013), although OS did not differ (6.0 vs 4.4 mo, p=0.56). In pts with CP-B and albumin-bilirubin (ALBI) grade 2, lenvatinib led to significantly longer PFS compared with sorafenib (4.2 vs. 1.4 mo, respectively; p=0.01). No significant difference was observed among pts with CP-B and ALBI grade 3 (1.2 vs 1.9, p=0.87). Conclusions: Among pts with CP-B liver function at progression on first-line Atezo-Bev, PPS differed according to the degree of liver dysfunction. Subsequent systemic therapy, particularly lenvatinib, might be associated with improved outcomes in this population.