The IMbrave150 trial established atezolizumab with bevacizumab (A+B) as standard care for hepatocellular carcinoma (HCC), recommending an esophagogastroduodenoscopy (EGD) within 6 months of treatment initiation to prevent bleeding from esophagogastric varices. The necessity of mandatory EGD for all patients remains unclear. We retrospectively analyzed 112 HCC patients treated with A+B at five Canadian cancer centers from 1 July 2020 to 31 August 2022. A+B was the first-line therapy for 90% of patients, with median overall survival at 20.3 months and progression-free survival at 9.6 months. There was no survival difference between patients with bleeding and those without. Before A+B, 71% (n = 79) of patients underwent an EGD within 6 months, revealing varices in 41% (n = 32) and requiring intervention in 19% (n = 15). The overall bleeding rate was 15% (n = 17), with GI-specific bleeding occurring in 5% (n = 17). In the EGD group, GI-specific bleeding was 6% (n = 5) while in the non-EGD group, it was 3% (n = 1). Non-GI bleeding was observed in 10% (n = 11) of patients. Outcomes for HCC patients treated with A+B in Canada were comparable to IMbrave150. There was no increase in GI bleeding in patients without pre-treatment EGD, possibly supporting a selective EGD approach.
IMbrave150试验确立了阿替利珠单抗联合贝伐珠单抗（A+B）作为肝细胞癌（HCC）的标准治疗方案，并建议在治疗开始后6个月内进行食管胃十二指肠镜检查（EGD）以预防食管胃静脉曲张出血。然而，对所有患者强制进行EGD的必要性尚不明确。本研究回顾性分析了2020年7月1日至2022年8月31日期间在加拿大五家癌症中心接受A+B治疗的112例HCC患者。其中90%的患者将A+B作为一线治疗，中位总生存期为20.3个月，无进展生存期为9.6个月。出血患者与未出血患者的生存期无显著差异。在开始A+B治疗前，71%（n=79）的患者在6个月内接受了EGD检查，其中41%（n=32）发现静脉曲张，19%（n=15）需要干预治疗。总体出血率为15%（n=17），其中胃肠道特异性出血占5%（n=17）。在接受EGD检查的患者中，胃肠道特异性出血率为6%（n=5），而在未接受EGD检查的患者中为3%（n=1）。此外，10%（n=11）的患者出现非胃肠道出血。加拿大接受A+B治疗的HCC患者疗效与IMbrave150试验结果相当。未进行预处理EGD的患者并未出现胃肠道出血风险增加，这可能支持选择性进行EGD的策略。
肿瘤(癌症)患者之家