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Turkish Journal of Gastroenterology
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Efficacy of Second-Line Treatments After Atezolizumab and Bevacizumab in Advanced Hepatocellular Carcinoma and Related Prognostic Factors: A Multicenter Study by the Turkish Oncology Group (TOG)

Nargiz Majidova 1 , Sendag Yaslıkaya 2 , Maral Martin Mıldanoglu 3 , Alper Coskun 4 , Duygu Ercan Uzundal 5 , Taha Koray Sahin 6 , Arif Akyildiz 6 , Sinem Akbas 7 , Ufuk Camanlı 8 , Elif Sahin 9 , Huseyin Atacan 10 , Ismail Bayrakcı 11 , Teoman Sakalar 12 , Ceren Mordag Cicek 13 , Damla Gunenc 14 , Nurullah İlhan 15 , Olcun Umit Unal 16 , Ozkan Alan 7 , Buket Hamitoglu 17 , Esra Ozen Engin 18 , Nadiye Sever 19 , Ali Kaan Guren 19 , Ahmet Unsal 20 , Murat Araz 21 , Bulent Erdogan 11 , Musa Barıs Aykan 10 , Fatih Selcukbiricik 7 , Deniz Can Guven 6 , Nuriye Ozdemir 5 , Ahmet Bilgehan Sahin 4 , Ahmet Bilici 3 , Ismail Oguz Kara 2 , Suayip Yalcın 6 , Osman Kostek 19
1.

Division of Medical Oncology, VM Medical Park Maltepe Hospital, İstanbul, Türkiye

2.

Division of Medical Oncology, Çukurova University School of Medicine, Adana, Türkiye

3.

Division of Medical Oncology, Medipol University Hospital, İstanbul, Türkiye

4.

Division of Medical Oncology, Uludağ University Faculty of Medicine, Bursa, Türkiye

5.

Division of Medical Oncology, Gazi University, Ankara, Türkiye

6.

Division of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Türkiye

7.

Division of Medical Oncology, Koç University Hospital, İstanbul, Türkiye

8.

Division of Medical Oncology, İzmir Bozyaka Training and Research Hospital, İzmir, Türkiye

9.

Division of Medical Oncology, Kocaeli City Hospital, Kocaeli, Türkiye

10.

Division of Medical Oncology, Gülhane Training and Research Hospital, Ankara, Türkiye

11.

Division of Medical Oncology, Trakya University, İstanbul, Türkiye

12.

Division of Medical Oncology, Kahramanmaraş Necip Fazıl City Hospital, Kahramanmaraş, Türkiye

13.

Division of Medical Oncology, Pamukkale University Hospital, Denizli, Türkiye

14.

Division of Tulay Aktas Oncology, Ege University, İzmir, Türkiye

15.

Division of Medical Oncology, İstanbul Sancaktepe Şehit Prof. Dr. İlhan Varank Training and Research Hospital, İstanbul, Türkiye

16.

Division of Medical Oncology, Tepecik Training and Research Hospital, İzmir, Türkiye

17.

Division of Medical Oncology, Eylül University Faculty of Medicine, İzmir, Türkiye

18.

Division of Medical Oncology, Sakarya University School of Medicine, Sakarya, Türkiye

19.

Division of Medical Oncology, Marmara University School of Medicine, İstanbul, Türkiye

20.

Division of Medical Oncology, Gümüşhane State Hospital, Gümüşhane, Türkiye

21.

Division of Medical Oncology, Necmettin Erbakan University Meram Medical Faculty Hospital, Konya

Turk J Gastroenterol 2019; 1: -
DOI: 10.5152/tjg.2025.24784
Keywords : Atezolizumab, bevacizumab, cabozantinib, hepatocellular carcinoma, overall survival, progression-free survival, regorafenib, second-line treatment, sorafenib
Read: 1865 Downloads: 943 Published: 07 April 2025
Volume 1, Issue 1, January 2019
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Background/Aims: The treatment of hepatocellular carcinoma (HCC), which accounts for 90% of all liver cancers, is highly varied. The use of second-line treatments following progression on first-line atezolizumab and bevacizumab (Atez/Bev) for advanced HCC remains controversial. The aim of this study was to analyze the real-world clinical results of second-line treatments in progression after Atez/Bev and to determine the factors affecting prognosis.


Materials and Methods: Fifty-eight patients treated with second-line sorafenib, regorafenib, and cabozantinib for progression after first-line Atez/Bev for advanced/metastatic HCC from 20 centers in Türkiye between October 2020 and June 2024 were retrospectively analyzed. Responses were evaluated by Response criteria, specifically Response Evaluation Criteria in Solid Tumors (RECIST v1.1) criteria. Median overall survival (OS) and progression-free survival (PFS) were computed with the Kaplan–Meier method. The Cox regression model was utilized to analyze multivariate analyses.


Results: About 82.8% of the patients were male and the median age of the whole group was 62 (range, 18-78) years. All patients progressed after first-line Atez/Bev and were given second-line treatment. The most commonly used second-line treatment option was sorafenib (70.7%), followed by regorafenib (12.1%) and cabozantinib (10.3%). Both median PFS (4.1 months) and median OS (7.8 months) were longer in patients treated with sorafenib compared to other treatments. In univariate analyses, Child–Pugh score B, high alpha-fetoprotein (AFP) levels (>200 ng/mL), extrahepatic spread, and Prognostic Nutritional Index (PNI) < 47.6 substantially raised the risk of overall mortality. Multivariate analysis showed that extrahepatic spread (HR (Hazard ratio): 0.41, P = .012), PNI level (HR: 0.24, P = .005), and AFP level (HR:1.97, P = .049) were independent predictors of OS.


Conclusion: Although second-line therapies after Atez/Bev show different degrees of efficacy, survival rates are consistent with the literature. Extrahepatic spread, AFP level, and PNI level are the main prognostic factors. In light of this information, personalized treatment strategies may improve outcomes for this challenging patient group.
 

Cite this article as: Majidova N, Yaslıkaya S, Mıldanoglu MM, et al. Efficacy of second-line treatments after atezolizumab and bevacizumab in advanced hepatocellular carcinoma and related prognostic factors: A multicenter study by the turkish oncology group (TOG). Turk J Gastroenterol. Published online April 7, 2025. doi 10.5152/tjg.2025.24784

       

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