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

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., PMI...

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 expectati...