Evidence map›Paper›PMID 37680945›Full record

ArticleEClinicalMedicine2023

Effectiveness and safety of atezolizumab-bevacizumab in patients with unresectable hepatocellular carcinoma: a systematic review and meta-analysis.

Anand V Kulkarni, Harshvardhan Tevethia, Karan Kumar, Madhumita Premkumar, Mark D Muttaiah, Atsushi Hiraoka, Takeshi Hatanaka, Toshifumi Tada, Takashi Kumada, Satoru Kakizaki and 6 more

Registry-linked trialOpen access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in EClinicalMedicine, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06903663 (A Multi-Centric, Retrospective, Real-World Study on First-Line Therapy With Atezolizumab Plus Bevacizumab for Advanced or Unresectable Hepatocellular Carcinoma in Romanian Population), which is not on this map. Cited by 45 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
45citing papers in PubMed, 2 pooled it
11.6field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT06903663 not yet recruitingnot on this mapstarted 2025, after this paper: background citation

A Multi-Centric, Retrospective, Real-World Study on First-Line Therapy With Atezolizumab Plus Bevacizumab for Advanced or Unresectable Hepatocellular Carcinoma in Romanian Population

TypeobservationalSponsorInstitutul Regional de Gastroenterologie & Hepatologie Prof. dr. Octavian FodorRan2025 to 2025Enrolled100ConditionsHepatocellular Carcinoma (HCC)
3 · Its place in the literature

Who cites it

45 citing papers in PubMed, 2 syntheses or guidelines pooled it, 57 citations in OpenAlex.

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  10. Efficacy and Safety of Atezolizumab Plus Bevacizumab for Patients With Hepatocellular Carcinoma and Child-Pugh Class B.Liver international : official journal of the International Association for the Study of the Liver · 2026
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

16 authors at 12 institutions in 5 countries.

Anand V KulkarniDepartment of Hepatology, Asian Institute of Gastroenterology, Hyderabad, India.
Harshvardhan TevethiaDepartment of Hepatology, ILBS, New Delhi, India.
Karan KumarDepartment of Hepatology, Mahatma Gandhi Medical College, Jaipur, India.
Madhumita PremkumarDepartment of Hepatology, PGIMER, Chandigarh, India.
Mark D MuttaiahYong Loo Lin School of Medicine, National University of Singapore, Singapore.
Atsushi HiraokaGastroenterology Centre, Ehime Prefectural Central Hospital, Matsuyama, Japan.
Takeshi HatanakaDepartment of Gastroenterology, Gunma Saiseikai Maebashi Hospital, Maebashi, Japan.
Toshifumi TadaDepartment of Internal Medicine, Japanese Red Cross Himeji Hospital, Hyogo, Japan.
Takashi KumadaDepartment of Nursing, Gifu Kyoritsu University, Ogaki, Japan.
Satoru KakizakiDepartment of Clinical Research, National Hospital Organization Takasaki General Medical Centre, Takasaki, Japan.
Arndt VogelMedizinische Hochschule Hannover, Hannover 30625, Germany.
Richard S FinnDivision of Hematology/Oncology, Department of Medicine, Geffen School of Medicine at UCLA, Santa Monica, CA, USA.
Padaki Nagaraja RaoDepartment of Hepatology, Asian Institute of Gastroenterology, Hyderabad, India.
Anjana PillaiDivision of Gastroenterology, Hepatology and Nutrition, Chicago, IL, USA.
Duvvur Nageshwar ReddyDepartment of Hepatology, Asian Institute of Gastroenterology, Hyderabad, India.
Amit G SingalDepartment of Medicine, UT Southwestern Medical Centre, Dallas, TX, USA.
Asian Institute of Gastroenterology · INEhime Prefectural Central Hospital · JPGandhi Medical College & Hospital · INGifu Kyoritsu University · JPGunma Saiseikai Maebashi Hospital · JPHimeji Red Cross Hospital · JPInstitute of Liver and Biliary Sciences · INMedizinische Hochschule Hannover · DENational Hospital Organization Takasaki Medical Center · JPNational University of Singapore · SGPost Graduate Institute of Medical Education and Research · INSouthwestern Medical Center · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background: Atezolizumab-bevacizumab (atezo-bev) is recommended as first-line therapy for patients with unresectable hepatocellular carcinoma (uHCC). However, its effectiveness and safety in other populations, including those with Child-Turcotte-Pugh (CTP) class B cirrhosis, is unclear. Methods: For this systematic review and meta-analysis, electronic databases, including PubMed, Embase, and Scopus, were searched from 1st May, 2020 till 5th October, 2022; the last date of access was January 31, 2023. Pooled progression-free survival (PFS), overall survival (OS), and radiological response rate among patients receiving atezo-bev were compared between patients with CTP-A and CTP-B cirrhosis, with tyrosine kinase inhibitors (TKIs) and among those receiving the drug as first-line and later line therapy. The protocol was registered in Prospero (CRD42022364430). Findings: Among 47 studies (n = 5400 patients), pooled PFS and OS were 6.86 (95% CI, 6.31-7.41) and 13.8 months (95% CI, 11.81-15.8), respectively. Objective response rate (ORR) and disease control rate were 26.7% (24.6-29.1) and 75.3% (73.1-77.4) using RECIST criteria, and 34% (30.3-37.8) and 73.6% (68.8-78) using mRECIST criteria, respectively. Among those receiving atezo-bev, patients with CTP-B cirrhosis had similar ORRs by RECIST (odds ratio [OR], 1.42 [0.77-2.6]; P = 0.25) and mRECIST criteria (OR, 1.33 [0.52-3.39]; P = 0.53) but shorter PFS (mean difference [MD]:3.83 months [1.81-5.84]) than those with CTP-A cirrhosis. Compared to patients receiving TKIs, those receiving atezo-bev had longer PFS (MD: 2.27 months [0.94-3.5]) and higher ORR (RECIST: OR, 1.44 [1.01-2.04] and mRECIST: OR, 1.33 [1.01-1.75]). Compared to first-line therapy, later-line therapy had lower ORR (RECIST: OR, 1.82 [1.3-2.53]; P < 0.001 and mRECIST: OR, 2.02 [1.34-3.05]) but comparable PFS (MD: 0.58 months [-0.18 to 1.35]) among nine studies. The incidence of grade ≥3 adverse events among patients with CTP-A and CTP-B cirrhosis was comparable (OR, 0.89 [0.45-1.74]) as it was for patients receiving atezo-bev and TKIs (OR, 0.86 [0.61-1.2]). Interpretation: Our findings suggest that atezo-bev is safe and effective as first-line systemic therapy for patients with uHCC and CTP-A or CTP-B cirrhosis. Funding: An unsolicited grant from ROCHE Products India Pvt Ltd. was received for publication.

Indexed as

Adverse eventsImmunotherapyLiver cancerRadiological response

Identifiers

PMID37680945
PMCPMC10480543
OpenAlexW4386300791

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.