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©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
Atezolizumab plus bevacizumab versus sorafenib or atezolizumab alone for unresectable hepatocellular carcinoma: A systematic review
Faiza Ahmed, Jennifer Onwumeh-Okwundu, Zeynep Yukselen, Maria-Kassandra Endaya Coronel, Madiha Zaidi, Prathima Guntipalli, Vamsi Garimella, Sravya Gudapati, Marc Darlene Mezidor, Kim Andrews, Mohamad Mouchli, Endrit Shahini
Faiza Ahmed, Zeynep Yukselen, Maria-Kassandra Endaya Coronel, Madiha Zaidi, Prathima Guntipalli, Division of Clinical and Translational Research, Larkin Community Hospital, South Miami, FL 33143, United States
Jennifer Onwumeh-Okwundu, Community Health Division, University of Stellenbosch, Stellenbosch 7602, South Africa
Vamsi Garimella, College of Medicine, Howard University, Washington, DC 520, United States
Sravya Gudapati, College of Medicine, Washington University of Health and Science, San Pedro, Belize
Marc Darlene Mezidor, Department of Radiology, Amita Health Saint Francis Hospital, Evaston, IL 60202, United States
Kim Andrews, Department of Mathematics and Natural Sciences, Prince Mohammad Bin Fahad University, Al Khobar 31952, Saudi Arabia
Mohamad Mouchli, Department of Gastroenterology, Cleveland Clinic, Cleveland, OH 44195, United States
Endrit Shahini, National Institute of Gastroenterology "S. de Bellis", Research Hospital, Castellana Grotte (Bari) 70013, Italy
Author contributions: Ahmed F, Onwumeh-Okwundu J, and Shahini E were the guarantors of the study; Ahmed F and Onwumeh-Okwundu J contributed to the study conception, design, and data acquisition, and supervised the drafting of the manuscript; Ahmed F, Mouchli M, and Shahini E critically reviewed the manuscript; Ahmed F, Endaya Coronel MK, Mouchli M, and Shahini E assisted in formatting, editing and revising the manuscript; All authors interpreted the data, participated in drafting the manuscript, critically revised the article for important intellectual content, and gave final approval of the article to be published.
Conflict-of-interest statement: The authors declare no conflict of interests for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
http://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Endrit Shahini, MD, MSc, National Institute of Gastroenterology "S. de Bellis", Research Hospital, Castellana Grotte (Bari), Via Turi 27, Castellana Grotte (Bari) 70013, Italy. endrit.shahini@irccsdebellis.it
Received: March 12, 2021
Peer-review started: March 12, 2021
First decision: May 3, 2021
Revised: May 11, 2021
Accepted: August 25, 2021
Article in press: August 25, 2021
Published online: November 15, 2021
ARTICLE HIGHLIGHTS
Research background
Despite the use of the current standard therapy, the prognosis of unresectable hepatocellular carcinoma (HCC) patients is poor, with median survival times of 40 mo in intermediate HCC (Barcelona Clinic Liver Cancer [BCLC] stage B) and 6–8 mo in advanced HCC (BCLC stage C). Although patients with early-stage HCC are usually suitable for therapies with curative intention, up to 70% of patients may manifest disease relapses at 5-year surveillance. Moreover, no treatment has been demonstrated to be useful in the adjuvant setting.
Research motivation
This systematic review described the evidence for atezolizumab/bevacizumab combination therapy vs sorafenib or atezolizumab monotherapies in improving survival outcomes and reducing disease progression in patients with unresectable HCC.
Research objectives
To evaluate the efficacy and safety of atezolizumab/bevacizumab vs sorafenib or atezolizumab alone, in patients with unresectable HCC with non-decompensated liver disease.
Research methods
A comprehensive literature review of published articles was conducted to identify studies that met our inclusion criteria using relevant mesh terms. This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and we assessed for risk of bias using the Cochrane ROB tool and Sevis tool to create the traffic light plots and summary plots.
Research results
There was an improvement in overall tumor response, reduction of disease progression, and longer progression-free survival in the atezolizumab/bevacizumab group compared to the monotherapy of either sorafenib or atezolizumab.
Research conclusions
This study confirms that combination treatment of atezolizumab plus bevacizumab could be a promising alternative to the standard of care sorafenib as a first-line treatment in patients with unresectable HCC and non-decompensated liver disease.
Research perspectives
Given the scarcity of randomized controlled trials specifically focusing on this therapeutic strategy, further research is needed to strengthen the current evidence. Two completed clinical trials were analyzed in this research; however, this review will be updated upon the completion of two ongoing trials. Moreover, further evaluation regarding the cost-effectiveness of combination therapy vs monotherapy is still needed valuable information.
