Hiệu quả điều trị bước một ung thư biểu mô tế bào gan bằng phác đồ Atezolizumab-bevacizumab
Nội dung chính của bài viết
Tóm tắt
Ung thư biểu mô tế bào gan là một loại ung thư phổ biến với nhiều cơ hội điều trị ở giai đoạn tiến triển trong những năm gần đây. Phác đồ Atezolizumab-Bevacizumab đã được FDA phê duyệt và được sử dụng tại Việt Nam từ năm 2020. Chúng tôi tiến hành một nghiên cứu mô tả, hồi cứu kết hợp tiến cứu trên 115 bệnh nhân HCC tại Bệnh viện Ung bướu Hà Nội, Bệnh viện Bạch Mai và Bệnh viện K từ tháng 5/2020 đến tháng 8/2024. Kết quả cho thấy tỷ lệ đáp ứng khách quan là 27,7%; tỷ lệ kiểm soát bệnh (DCR) là 67,8%. Các yếu tố ảnh hưởng đến tỷ lệ đáp ứng lâm sàng (DCR): ECOG, phân loại Child-Pugh, nồng độ AFP, vị trí khối u gan, phân loại huyết khối tĩnh mạch cửa, tình trạng di căn xa. Do đó, phác đồ Atezolizumab-Bevacizumab được sử dụng làm phương pháp điều trị bước một cho bệnh nhân ung thư biểu mô tế bào gan không thể phẫu thuật với tỷ lệ đáp ứng và tỷ lệ kiểm soát bệnh cao trong thực tiễn lâm sàng.
Chi tiết bài viết
Từ khóa
Ung thư biểu mô tế bào gan, Atezolizumab- Bevacizumab, bước 1, tỉ lệ đáp ứng, tỉ lệ kiểm soát bệnh
Tài liệu tham khảo
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12. Kournoutas I, Marell P, Gile J, et al. First-line atezolizumab/bevacizumab or durvalumab/tremelimumab in advanced hepatocellular carcinoma: a real world, multicenter retrospective study. The Oncologist. 2025; 30(11): oyaf286. doi:10.1093/oncolo/oyaf286.
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15. Huang D, Ke L, Cui H, et al. Efficacy and safety of PD-1/PD-L1 inhibitors combined with anti-angiogenic therapy for the unresectable hepatocellular carcinoma and the benefit for hepatitis B virus etiology subgroup: a systematic review and meta-analysis of randomized controlled trials. BMC Cancer. 2023; 23(1): 474. doi:10.1186/s12885-023-10960-w.
16. Ferrando-Martinez S, Snell Bennett A, Lino E, et al. Functional Exhaustion of HBV-Specific CD8 T Cells Impedes PD-L1 Blockade Efficacy in Chronic HBV Infection. Front Immunol. 2021; 12: 648420. doi:10.3389/fimmu.2021.648420.
17. Prognostic Factor Analysis of Atezolizumab-Bevacizumab in Unresectable Hepatocellular Carcinoma: Korean Cancer Study Group Study. Gastroenterol Hepatol. 2021; 17(11 Suppl 6): 17-18.
18. Teng W, Lin CC, Su CW, et al. Combination of CRAFITY score with Alpha-fetoprotein response predicts a favorable outcome of atezolizumab plus bevacizumab for unresectable hepatocellular carcinoma. Am J Cancer Res. 2022; 12(4): 1899-1911.
19. Park J, Lee DH, Hur MH, et al. Prognostic Impact of Varices and Hemorrhagic Events in Hepatocellular Carcinoma Patients Treated with Atezolizumab Plus Bevacizumab. Gut Liver. doi:10.5009/gnl250133.
20. Song BG, Goh MJ, Kang W, et al. Analysis of Factors Predicting the Real-World Efficacy of Atezolizumab and Bevacizumab in Patients with Advanced Hepatocellular Carcinoma. Gut Liver. 2024; 18(4): 709-718. doi:10.5009/gnl240085.
2. Liu X, Lu Y, Qin S. Atezolizumab and bevacizumab for hepatocellular carcinoma: mechanism, pharmacokinetics and future treatment strategies. Future Oncol. 2021; 17(17): 2243-2256. doi:10.2217/fon-2020-1290.
3. Zhao J, Zhang Y, Qin S, et al. Hepatitis B Virus Reactivation in Cancer Patients Undergoing Immune Checkpoint Inhibitors Therapy: A Systematic Review. J Cancer. 2022; 13(14): 3539-3553. doi:10.7150/jca.77247.
4. Espinoza M, Muquith M, Lim M, et al. Disease Etiology and Outcomes After Atezolizumab Plus Bevacizumab in Hepatocellular Carcinoma: Post-Hoc Analysis of IMbrave150. Gastroenterology. 2023; 165(1): 286-288.e4. doi:10.1053/j.gastro.2023.02.042.
5. Brown TJ, Mamtani R, Gimotty PA, et al. Outcomes of hepatocellular carcinoma by etiology with first-line atezolizumab and bevacizumab: a real-world analysis. J Cancer Res Clin Oncol. 2023; 149(6): 2345-2354. doi:10.1007/s00432-023-04590-9.
6. Kulkarni A, Krishna V, Kumar K, et al. Safety and Efficacy of Atezolizumab-Bevacizumab In Real-World -The First Indian Experience. J Clin Exp Hepatol. 2023; 13. doi:10.1016/j.jceh.2023.02.003.
7. Shao M, Tan B, Fan C, et al. Effectiveness and Safety of Atezolizumab Plus Bevacizumab in Unresectable Hepatocellular Carcinoma: A Multicenter, Retrospective Real-World Study in China. Clin Med Insights Oncol. 2026; 20. doi:10.1177/11795549251414656.
8. Kulkarni AV, Tevethia H, Kumar K, et al. Effectiveness and safety of atezolizumab-bevacizumab in patients with unresectable hepatocellular carcinoma: a systematic review and meta-analysis. eClinicalMedicine. 2023; 63: 102179. doi:10.1016/j.eclinm.2023.102179.
9. Gairing SJ, Mildenberger P, Gile J, et al. Evaluation of prognostic scores in patients with HCC undergoing first-line immunotherapy with atezolizumab and bevacizumab. JHEP Rep. 2024; 7(3): 101295. doi:10.1016/j.jhepr.2024.101295.
10. Claudia Campani, Dimitrios Pallas, Sabrina Sidali, et al. Heterogeneity in adverse events related to atezolizumab-bevacizumab for hepatocellular carcinoma reported in real-world studies. JHEP Rep. 2024 Aug 22; 6(11): 101190. doi: 10.1016/j.jhepr.2024.101190.
11. Allaire M, Thiam EM, Amaddeo G, et al. Real-World Outcomes of Atezolizumab-Bevacizumab in Hepatocellular Carcinoma: The Prospective French CHIEF Cohort. Liver Int Off J Int Assoc Study Liver. 2025; 45(10): e70337. doi:10.1111/liv.70337.
12. Kournoutas I, Marell P, Gile J, et al. First-line atezolizumab/bevacizumab or durvalumab/tremelimumab in advanced hepatocellular carcinoma: a real world, multicenter retrospective study. The Oncologist. 2025; 30(11): oyaf286. doi:10.1093/oncolo/oyaf286.
13. Biomarkers and prognostic factors of PD-1/PD-L1 inhibitor-based therapy in patients with advanced hepatocellular carcinoma - PMC. Accessed January 30, 2026. https://pmc.ncbi.nlm.nih.gov/articles/PMC10865587/.
14. Wang X, Chen S, Yu W, et al. A Retrospective Study of Hepatic Arterial Infusion Chemotherapy Combined with Tyrosine Kinase Inhibitors and PD-1 Inhibitors in Hepatocellular Carcinoma Patients with Main Portal Vein Tumor Thrombus (VP4). J Hepatocell Carcinoma. 2026; Volume 13:1-14. doi:10.2147/JHC.S562766.
15. Huang D, Ke L, Cui H, et al. Efficacy and safety of PD-1/PD-L1 inhibitors combined with anti-angiogenic therapy for the unresectable hepatocellular carcinoma and the benefit for hepatitis B virus etiology subgroup: a systematic review and meta-analysis of randomized controlled trials. BMC Cancer. 2023; 23(1): 474. doi:10.1186/s12885-023-10960-w.
16. Ferrando-Martinez S, Snell Bennett A, Lino E, et al. Functional Exhaustion of HBV-Specific CD8 T Cells Impedes PD-L1 Blockade Efficacy in Chronic HBV Infection. Front Immunol. 2021; 12: 648420. doi:10.3389/fimmu.2021.648420.
17. Prognostic Factor Analysis of Atezolizumab-Bevacizumab in Unresectable Hepatocellular Carcinoma: Korean Cancer Study Group Study. Gastroenterol Hepatol. 2021; 17(11 Suppl 6): 17-18.
18. Teng W, Lin CC, Su CW, et al. Combination of CRAFITY score with Alpha-fetoprotein response predicts a favorable outcome of atezolizumab plus bevacizumab for unresectable hepatocellular carcinoma. Am J Cancer Res. 2022; 12(4): 1899-1911.
19. Park J, Lee DH, Hur MH, et al. Prognostic Impact of Varices and Hemorrhagic Events in Hepatocellular Carcinoma Patients Treated with Atezolizumab Plus Bevacizumab. Gut Liver. doi:10.5009/gnl250133.
20. Song BG, Goh MJ, Kang W, et al. Analysis of Factors Predicting the Real-World Efficacy of Atezolizumab and Bevacizumab in Patients with Advanced Hepatocellular Carcinoma. Gut Liver. 2024; 18(4): 709-718. doi:10.5009/gnl240085.