How would you manage a patient with metastatic HCC on atezolizumab/bevacizumab who requires holding bevacizumab due to persistent proteinuria >2g?

Topics: Gastrointestinal Cancers • Medical Oncology • Liver and Pancreas Tumors

Do you continue atezo alone if responding or switch to an alternative therapy such as dual IO or TKI? What about if the patient were experiencing subtle progression due to holding bevacizumab?

Answer from: Medical Oncologist at Academic Institution

This is a great clinical question, one that we often see since the approval of atezolizumab/bevacizumab in first line setting for HCC. Incidence of proteinuria with bevacizumab has been reported anywhere from 0.8%-4% for grade 3 (more than 3.5 g in a 24-hour urine protein level) (Brandes et al....

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Medical Oncologist at Clinical Instructor
Thank you Dr. @Nguyen H. Tran for your answer! Doe...

Medical Oncologist at Mayo Clinic, Rochester
The data suggests that it is bevacizumab, more pro...

Answer from: Medical Oncologist at Academic Institution

If no progression and good tolerance of single agent atezo, would continue atezo. Would also investigate other possibilities for proteinuria and often start ACEI/ARB which may improve to 1+ and can consider resuming bev in that context. If progressing on single agent atezo, little data or exp...

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