Immunotherapy in hepatocellular carcinoma: evaluation and management of adverse events associated with atezolizumab plus bevacizumab.
Chiun HsuLorenza RimassaHui-Chuan SunArndt VogelAhmed O KasebPublished in: Therapeutic advances in medical oncology (2021)
In light of positive efficacy and safety findings from the IMbrave150 trial of atezolizumab plus bevacizumab, this novel combination has become the preferred first-line standard of care for patients with unresectable hepatocellular carcinoma (HCC). Several additional trials are ongoing that combine an immune checkpoint inhibitor with another agent such as a multiple kinase inhibitor or antiangiogenic agent. Therefore, the range of first-line treatment options for unresectable HCC is likely to increase, and healthcare providers need succinct information about the use of such combinations, including their efficacy and key aspects of their safety profiles. Here, we review efficacy and safety data on combination immunotherapies and offer guidance on monitoring and managing adverse events, especially those associated with atezolizumab plus bevacizumab. Because of their underlying liver disease and high likelihood of portal hypertension, patients with unresectable HCC are at particular risk of gastrointestinal bleeding, and this risk may be exacerbated by treatments that include antiangiogenic agents. Healthcare providers also need to be alert to the risks of proteinuria and hypertension, colitis, hepatitis, and reactivation of hepatitis B or C virus infection. They should also be aware of the possibility of rarer but potentially life-threatening adverse events such as pneumonitis and cardiovascular events. Awareness of the risks associated with these therapies and knowledge of adverse event monitoring and management will become increasingly important as the therapeutic range broadens in unresectable HCC.
Keyphrases
- healthcare
- cardiovascular events
- locally advanced
- liver metastases
- blood pressure
- metastatic colorectal cancer
- coronary artery disease
- rectal cancer
- human health
- cardiovascular disease
- clinical trial
- squamous cell carcinoma
- health information
- electronic health record
- study protocol
- quality improvement
- randomized controlled trial
- rheumatoid arthritis
- emergency department
- interstitial lung disease
- affordable care act
- big data
- chronic pain
- risk assessment
- phase ii
- machine learning
- pain management
- climate change