New Delhi: A groundbreaking study conducted in India has found that a combination of two drugs that boost the immune system can help liver cancer patients live longer and better.
The study, which is the first-of-its-kind to test the efficacy of a combination of atezolizumab and bevacizumab — in real world settings (outside clinical trials) — has shown remarkable results in improving the survival and quality of life of patients with advanced liver cancer, even offering complete resolution of tumour in certain cases.
The study was done by doctors and researchers from the Asian Institute of Gastroenterology, Hyderabad, and Mahatma Gandhi Medical College, Jaipur, who used a combination of atezolizumab-bevacizumab immunotherapy drugs to treat 67 patients from November 2020 to July 2022.
The results, which were published in the Journal of Clinical and Experimental Hepatology in July this year, showed that the therapy stopped the cancer from growing in more than two-thirds of the patients. Some of them even had their tumours completely disappear.
The combination of atezolizumab and bevacizumab drugs uses the immune system of the body to kill the cancer cells, the study has found.
“The combination was found to be safe and effective in unresectable hepatocellular carcinoma (uHCC) in real-world settings,” the researchers noted.
“With the right selection of patients, atezolizumab-bevacizumab can achieve a good response in terms of survival period and disappearance of tumour (resolution of tumour),” they added.
Talking about the study at a press conference in Hyderabad Thursday, Dr Anand Kulkarni, senior consultant with the department of hepatology and liver transplantation at the Asian Institute of Gastroenterology, Hyderabad, and the lead author of the study, however, noted that the drugs must be given under supervision every three weeks and are not suitable for all patients, especially those with jaundice.
Moreover, the study also discovered the rising incidence of non-alcoholic steatohepatitis (NASH) — an advanced form of non-alcoholic fatty liver disease — as an emerging cause of liver cancer.
Dr Nageshwar Reddy, chairman and chief of gastroenterology, AIG Hospitals, who was also present at the press conference, highlighted that liver cancer has emerged as one of the most frequently encountered cancers in the gastrointestinal and liver clinics in recent years.
“The cause of liver cancer was said to be viral hepatitis B for a long time, but the trend is now changing to non-alcoholic steatohepatitis (NASH or fatty liver), apart from Hepatitis B and C virus infections, liver cirrhosis, and alcohol intake,” he said.
The reason for rise in NASH, the doctor added, could be attributed to sedentary lifestyle, unhealthy dietary habits, and an increasing incidence of diabetes.
“Treatment for these patients was limited to oral tablets, but a newer immunotherapy treatment may revolutionise the treatment of advanced liver cancer,” Rao added.
The numbers associated with the disease globally, including India, are staggering. According to a study published in an American journal, liver cancer is one of the deadliest forms of cancer with only 18 percent of those with liver cancer alive five years after diagnosis.
Globally, liver cancer is the fourth most common cause of cancer-related deaths, and in India it is the eighth most common cause of cancer-related deaths.
Meanwhile, in terms of its effect on men and women, the information shared by the Indian Council of Medical Research says the age-adjusted incidence rate of liver cancer/hepatocellular carcinoma for men ranges from 0.7 to 7.5 and for women 0.2 to 2.2 per 100,000 of population per year.
The age standardised mortality rate for liver cancer in the country for men is 6.8 per 100,000 and for women it is 5.1 per 100,000 population per year, it added.
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The study and its results
The researchers treated 67 patients with unresectable hepatocellular carcinoma (uHCC) — a type of liver cancer that cannot be removed by surgery — with the immunotherapy combination between November 2020 and July 2022.
The results highlighted that, with the use of the therapy, the disease did not progress in 66.12 percent of the patients. Moreover, 12.9 percent of the patients achieved complete resolution of tumour, meaning that there was no evidence of cancer left in their bodies, while another 25.8 percent of the patients achieved partial resolution or shrinking of tumours.
The study demonstrated that the immunotherapy combination of atezolizumab and bevacizumab improved the survival outcomes of patients with advanced liver cancer.
The patients who received this treatment had an overall survival of 21 months, which means they lived for 21 months after receiving the treatment. The average age of the 67 patients who participated in the study was 61 years (ranging from 29-82), and most of them were males (86 percent).
The researchers also found that the patients who had received local radiation therapy and atezolizumab-bevacizumab combination had better response rates.
“Immunotherapy, such as atezolizumab and bevacizumab, can provide a decent survival chance for patients presenting at an advanced stage of liver cancer, but is also an excellent therapy for patients with early stage liver cancer,” said Dr Anand Kulkarni.
The combination is recommended as first-line therapy for advanced stage liver cancer patients by several international organisations and has shown to be effective for patients with preserved liver functions, but this is the first systematic evidence of its efficacy in Indian patients.
(Edited by Richa Mishra)
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