AT A GLANCE

A new study published in European Radiology reports on the development and use of a new imaging-based tool to predict early progression to atezolizumab plus bevacizumab (Atezo-Bev) therapy in advanced hepatocellular carcinoma (HCC).¹

“No validated imaging-based tool currently exists to predict early progression to Atezo-Bev therapy in advanced HCC,” explain study authors Park et al., who therefore sought to develop a predictive model incorporating both clinical and imaging findings to predict early progression in patients with advanced HCC undergoing Atezo-Bev therapy.

The authors retrospectively enrolled 140 consecutive patients with HCC who initiated Atezo-Bev therapy at two tertiary care centers for analysis. For study purposes, early progression was defined by progressive disease confirmed in the first response evaluation conducted at 4 and 12 weeks after treatment initiation using dynamic computed tomography or magnetic resonance imaging.

According to the authors, the first response evaluation of Atezo-Bev therapy was conducted at a median of 56 days after treatment initiation, with approximately 40% of patients with HCC showing early progression.

For study purposes, the early progression score was defined as follows: (age < 60 years; 1 point) + (serum alpha-fetoprotein level ≥ 300 ng/mL; 3 points) + (neutrophil-to-lymphocyte ratio ≥ 2.8; 1 point) + (infiltrative appearance; 2 points). At a score of ≥3 points, the early progression score showed a sensitivity of 91.1% and a specificity of 53.6% (95% CI: 42.9-64.2%), while, at a score of ≥6, the score demonstrated a sensitivity of 55.4% and a specificity of 91.7%, respectively.

“We developed an early progression score that integrates clinical and imaging factors with high specificity to accurately predict early progression in patients with advanced HCC undergoing Atezo-Bev therapy,” conclude the authors. “Infiltrative tumor appearance, high alpha-fetoprotein, high neutrophil-to-lymphocyte ratio, and younger age were significantly associated with early progression.”

Reference

1.     Park JH, Goh MJ, Sinn DH, Shin J, Rhee H. Predicting early progression to atezolizumab–bevacizumab in hepatocellular carcinoma: a clinical and imaging-based scoring system (online ahead of print October 4, 2025). Eur Radiol.