Young Eun Seo, Chan Joong Bae, Won Jae Lee, Sun Young Chun, Jun Sik Yoon, Yang-Hyun Baek, Yeo Wool Kang, Woo Sun Rou, Jeong Eun Song, Joonho Jeong, Young Mi Hong, Sang Youn Hwang, Hyun Chin Cho, Jung Pyo Hong, Hyun Young Woo, Jeong Heo, Yu Rim Lee, Soo Young Park, Won Young Tak, Jae Hyun Yoon, Sung Bum Cho
Ate/Bev achieved similar antitumor response rates in high-risk and non-high-risk patients, but survival remained poorer in the high-risk group. High-risk status therefore did not preclude antitumor activity with Ate/Bev.
BACKGROUND/OBJECTIVES: Real-world data in high-risk patients remain limited; this study evaluated survival, safety, and prognostic factors in this patient group.
METHODS: This multicenter study retrospectively reviewed 783 patients who received Ate/Bev from 2022-2024 across South Korea. High-risk patients (n = 252, 32.2%) were defined by main portal vein tumor thrombus (Vp4), tumor occupancy ≥50% of liver volume, or bile duct invasion. Propensity score matching (PSM) was performed to balance host-related factors between the high-risk and non-high-risk (n = 531) groups.
RESULTS: After PSM (251 pairs, n = 502), overall survival (median 10.4 vs. 14.9 months; HR 1.57, 95% CI 1.28-1.92, p < 0.001) and progression-free survival (median 6.0 vs. 6.8 months; HR 1.29, 95% CI 1.08-1.53, p = 0.009) remained significantly worse in the high-risk group. Objective response (25.1% vs. 19.9%, p = 0.200) and disease control rates (71.7% vs. 76.5%, p = 0.262) were comparable. Among 103 responders with documented response-onset dates, an exploratory complete-case analysis showed a numerically shorter duration of response in the high-risk group, although the difference did not reach statistical significance (median, 7.1 vs. 11.3 months; HR, 1.57; 95% CI, 0.97-2.55; p = 0.065).
CONCLUSIONS: Ate/Bev achieved similar antitumor response rates in high-risk and non-high-risk patients, but survival remained poorer in the high-risk group. High-risk status therefore did not preclude antitumor activity with Ate/Bev.