Hepatitis C Eradication Improves Oncologic and Clinical Outcomes in Patients Treated With Atezolizumab Plus Bevacizumab
Year: 2025
Type: article
Study design: Observational Study
Abstract: BACKGROUND AND AIMS: Hepatitis C virus (HCV) is a key driver of hepatocellular carcinoma (HCC). However, the impact of HCV eradication on systemic therapy remains unclear. We aimed to assess the safety and efficacy of direct-acting antivirals (DAA) in patients treated with Atezolizumab plus Bevacizumab (AtezoBev). METHODS: This retrospective multicentre study included patients with HCV-related unresectable/advanced HCC treated with AtezoBev between 2021 and 2024. Three groups of patients were compared: Group A (n = 22), concurrent DAA with AtezoBev; Group B (n = 95), antiviral therapy before AtezoBev; and Group C (n = 22), active infection. RESULTS: Group A showed the longest median overall survival (42.8 months) compared to Group B (26.8 months; p = 0.03) and Group C (19.7 months; p = 0.01). Time to progression and progression-free survival were significantly prolonged in Group A versus Groups B and C. Moreover, Group A exhibited a higher disease control rate than the other groups. Post-DAA decompensation rates were significantly lower in Group A (4.5%) compared to Groups B (26.3%) and C (36.4%). Treatment-related adverse events of grade ≥ 3 were similar across groups. In the multivariate competing risk analysis with adjustment for time-dependent variables, achieving sustained virologic response during AtezoBev showed a protective effect against liver decompensation (sHR 0.02, p = 0.003) or tumour progression (sHR 0.14, p = 0.009), and was also associated with reduced mortality (HR 0.29, p = 0.005). CONCLUSIONS: Achieving a SVR during AtezoBev seems to improve oncologic outcomes and reduce liver decompensation in patients with unresectable/advanced HCC. An integrated therapeutic approach can optimise systemic treatment efficacy, particularly in patients eligible for conversion strategies. TRIAL REGISTRATION: Protocol ID: 5890.
Source: Liver International
DOI: 10.1111/liv.70362
Authors: Leonardo Stella, Giuseppe Cabibbo, Ciro Celsa, Roberta Ciccia, Alba Sparacino, Fabio Piscaglia, Francesco Tovoli, Andrea Arleo, Bernardo Stefanini, Massimo Iavarone, Roberta D'Ambrosio, Lucia Cerrito, Maria Pallozzi, Francesco Santopaolo, Fabio Marra, Claudia Campani, Chiara Mazzarelli, Raffaella Viganò, Raffaella Tortora, Alessio Aghemo, Stella De Nicola, Tiziana Pressiani, Lorenza Rimassa, Sherrie Bhoori, Salvatore Corallo, Laura Maiocchi, Andrea Martini, Caterina Soldà, Francesco Paolo Russo, Antonio Gasbarrini, Francesca Romana Ponziani
Institutions: Agostino Gemelli University Polyclinic, Azienda Ospedaliera Universitaria Policlinico "Paolo Giaccone" di Palermo, Imperial College London, University of Bologna, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Florence, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Ospedale Antonio Cardarelli, Humanitas University, IRCCS Humanitas Research Hospital, Fondazione IRCCS Istituto Nazionale dei Tumori, University of Pavia, Policlinico San Matteo Fondazione, University of Padua, Azienda Ospedale - Università Padova, Istituto Oncologico Veneto, Università Cattolica del Sacro Cuore
Language: English
Topic: Hepatitis C virus research
Subfield: Hepatology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,780
Funder: Fondazione Roma
Award: G3011592554
OpenAlex ID: W4414422342