CHA Bundang identifies risk factor in using Tecentriq+Avastin combo to treat liver cancer

CHA Bundang Medical Center identified the gastroesophageal variceal bleeding risk factor when using a combination therapy of Tecentriq (ingredient: atezolizumab) and Avastin (bevacizumab) for treating  hepatocellular carcinoma (HCC). 

HCC is the sixth most common cancer worldwide, but the development of treatment is slow compared to other solid cancers. The five-year relative survival rate of metastatic HCC has remained the same for the past 10 years, so the development of new treatments has been urgently needed.

In March, the American Society of Clinical Oncology (ASCO) and the National Comprehensive Cancer Centers Network (NCCN) revised guidelines and recommended a combination therapy of Tecentriq and Avastin, significantly changing the treatment direction for unresectable liver cancer.

However, in actual clinical practice, there has been no study to identify the risk of gastroesophageal variceal bleeding and predictable risk factors before using the combination therapy of Tecentriq and Avastin.

Therefore, the team, led by Professors Jun Hong-jae of the Department of Hemato-oncology and Ha Yeon-jung of the Department of Gastroenterology, analyzed 194 liver cancer patients who received Tecentriq and Avastin combo and confirmed that gastroesophageal variceal bleeding occurred in 4.1 percent of patients.

Notably, the risk of gastroesophageal variceal bleeding increased more than six times in patients with liver cancer that metastasized to the main portal vein than those without metastasis.

Also, high-risk varices were found in all patients who developed gastroesophageal variceal bleeding during the comobo treatment.

The team also confirmed that prophylactic endoscopic variceal ligation could reduce the risk of variceal bleeding in patients with high-risk varicose veins.

“Tecentriq and Avastin combination therapy proved its safety by confirming the occurrence of gastroesophageal variceal bleeding in 2.7 percent of patients during the existing global clinical study IMbrave150,” Professor Jun said. “However, as the results were conducted only on selected patients, there were concerns that may be higher in the actual treatment field.”

The team expects this study to make it possible for HCC patients to receive combination therapy treatment with greater confidence, Jun added.

Professor Ha also said, “The current treatment guidelines require that all patients undergo endoscopy to confirm the risk of bleeding before receiving the Tecentriq and Avastin combination therapy and start treatment after receiving endoscopic preventive measures.”

The results of this study will serve as an important guideline for screening patients with Tecentriq and Avastin combination therapy that must undergo endoscopy and appropriately cope with the risk of bleeding through clinical indicators, Ha added.

Clinical Gastroenterology and Hepatology published the result of the study.