Angiotensin Receptor Neprilysin Inhibitors for Hypertension and Proteinuria Management During Atezolizumab/Bevacizumab Treatment for Hepatocellular Carcinoma
Year: 2025
Type: article
Study design: Observational Study
Abstract: Background/Aim: Vascular endothelial growth factor (VEGF) inhibitors, such as bevacizumab (Bev), are key in the pharmacological treatment of advanced hepatocellular carcinoma (HCC) but are associated with a high incidence of adverse events, including hypertension and proteinuria. Strategies to reduce proteinuria through blood pressure control are particularly important. A new angiotensin receptor neprilysin inhibitor (ARNI) (sacubitril/valsartan) was recently approved for the treatment of hypertension. ARNI exerts its antihypertensive effects through vasodilation, sympathomimetic inhibition, and natriuresis by enhancing the action of natriuretic peptides, together with suppression of the renin-angiotensin system by angiotensin II receptor blockers (ARB). Herein, the aim was to investigate the efficacy of ARNI for blood pressure control and proteinuria in advanced hepatocellular carcinoma (HCC) patients during treatment with atezolizumab plus Bev (Atez/Bev). Patients and Methods: We retrospectively identified patients with advanced HCC under Atez/Bev treatment, who experienced inadequate blood pressure control with ARB and were transitioned to ARNI. Data on estimated glomerular filtration rate (eGFR), urinary protein/creatinine ratio (UPCR), and Bev continuation were analyzed. Results: The mean patient age was 76.6 years, and the liver background was hepatitis B virus (HBV) (n=1), hepatitis C virus (HCV) (n=4), or non-HBV/non-HCV (n=5). eGFR significantly improved from a mean of 52.87 to 59.46 ml/min/1.73 m2 (p=0.006); UPCR decreased from 2.31 to 0.79 (p=0.025) after switching to ARNI. Among patients with UPCR ≥2 (n=5), switch from ARB to ARNI improved eGFR from 50.54 to 58.62 ml/min/1.73 m2, (p=0.026), while UPCR decreased from a mean of 3.99 to 1.13 (p=0.025), allowing uninterrupted Bev treatment. Conclusion: ARNI appears to support renal function preservation and proteinuria reduction during Atez/Bev therapy, allowing the continuation of Bev treatment.
Source: Cancer Diagnosis & Prognosis
DOI: 10.21873/cdp.10462
Authors: TORU ISHIKAWA, RYO SATO, HIROKI NATSUI, TAKAHIRO IWASAWA, MASAHIRO OGAWA, YUJI KOBAYASHI, TOSHIFUMI SATO, JUNJI YOKOYAMA, TERASU HONMA
Language: English
Subfield: Hepatology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W4411977968