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TOPLINE:

Patients with advanced hepatocellular carcinoma (HCC) receiving atezolizumab-bevacizumab treatment were more likely to experience variceal bleeding if they had a low platelet count, main portal vein invasion, varices needing treatment, or a history of gastrointestinal bleeding.

METHODOLOGY:

• Atezolizumab-bevacizumab is the standard of care for advanced HCC, yet real-world data on the risk for variceal bleeding after its use are limited.
• Researchers conducted a retrospective analysis to investigate the risk for variceal bleeding in patients with HCC who received at least one dose of atezolizumab-bevacizumab.
• All patients had undergone esophagogastroduodenoscopy (OGD) within 1 year before atezolizumab-bevacizumab treatment.
• The primary outcome was the occurrence of variceal bleeding, identified as either confirmed active bleeding on OGD or suspected variceal bleeding with symptoms of gastrointestinal bleeding, such as hematemesis, melena, and a ≥ 2 g/dL decrease in hemoglobin levels from baseline, followed by endoscopic variceal ligation.

TAKEAWAY:

• Researchers included 640 patients (mean age, 61.3 years; 82.5% men), with chronic hepatitis B infection as the leading cause of HCC (69.5%) and most having stage C cancer (88.0%).
• During the median follow-up period of 5.6 months, 7% patients developed variceal bleeding, with cumulative incidence rates of 6.3% at 6 months and 7.4% at 12 months.
• Significant risk factors associated with variceal bleeding were main portal vein invasion (adjusted subdistribution hazard ratio [aSHR], 3.49; P = .001), low platelet count (aSHR, 0.994 per 1000/mm³ decrease; P = .004), a history of gastrointestinal bleeding (aSHR, 3.70; P = .005), and varices needing treatment on OGD (aSHR, 2.67; P = .010).
• All bleeding events were successfully treated with endoscopic variceal ligation and conservative treatment, with no mortality events reported.

IN PRACTICE:

“This study identified critical baseline risk factors for [variceal bleeding], including main [portal vein invasion], [varices needing treatment], low platelet count, and a history of [gastrointestinal] bleeding, offering practical insights for clinicians managing high-risk patients,” the authors wrote.

SOURCE:

This study, published online in Alimentary Pharmacology & Therapeutics, was led by Kanghee Park and Jonggi Choi of the University of Ulsan College of Medicine, Hye Won Lee of the Yonsei University College of Medicine, and Seungbong Han of the Korea University College of Medicine, Seoul, Republic of Korea. 

LIMITATIONS:

Selection bias may have been introduced due to the retrospective nature of the study. The administration of prophylaxis for variceal bleeding was based on the discretion of physicians and not a uniform protocol. The inclusion criterion of pretreatment endoscopy within 1 year of treatment initiation may not have accurately represented current variceal conditions, as portal hypertension can progress with HCC. The study population predominantly comprised patients with hepatitis B virus infection, potentially limiting generalizability to populations with different etiologies.

DISCLOSURES:

This study was supported by grants from the National Research Foundation of Korea and Gilead Sciences. One author reported receiving a research grant from Gilead Sciences.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.