Prospective Study of Atezolizumab Plus Bevacizumab for Unresectable Hepatocellular Carcinoma Based on Hepatobiliary Phase of Gd-EOB-DTPA-MRI.
[BACKGROUND] Signal intensity on the hepatobiliary phase of gadolinium-ethoxybenzyl-diethylenetriamine (Gd-EOB-DTPA)-magnetic resonance imaging (MRI) reflects Wnt/β-catenin signaling activity in hepat
- p-value p = 0.033
APA
Aoki T, Kudo M, et al. (2026). Prospective Study of Atezolizumab Plus Bevacizumab for Unresectable Hepatocellular Carcinoma Based on Hepatobiliary Phase of Gd-EOB-DTPA-MRI.. Hepatology research : the official journal of the Japan Society of Hepatology. https://doi.org/10.1111/hepr.70157
MLA
Aoki T, et al.. "Prospective Study of Atezolizumab Plus Bevacizumab for Unresectable Hepatocellular Carcinoma Based on Hepatobiliary Phase of Gd-EOB-DTPA-MRI.." Hepatology research : the official journal of the Japan Society of Hepatology, 2026.
PMID
41862780
Abstract
[BACKGROUND] Signal intensity on the hepatobiliary phase of gadolinium-ethoxybenzyl-diethylenetriamine (Gd-EOB-DTPA)-magnetic resonance imaging (MRI) reflects Wnt/β-catenin signaling activity in hepatocellular carcinoma (HCC), and has been associated with poor response to immune monotherapy. However, whether such imaging findings predict resistance to combination immunotherapy has not been prospectively validated.
[METHODS] This multicenter prospective study enrolled 152 patients with unresectable HCC treated with atezolizumab plus bevacizumab across 12 Japanese centers. All had Child-Pugh class A liver function and underwent Gd-EOB-DTPA-MRI prior to treatment. Hyperintensity was defined as a relative enhancement ratio ≥ 0.9. Treatment outcomes, including objective response rate (ORR), progression-free survival (PFS), overall survival (OS), and time to partial response (TtPR), were compared between patients with and without hyperintense nodules.
[RESULTS] Of the 152 patients, 82 received immunotherapy as the first-line and 70 as a later-line therapy. Hyperintense nodules were identified in 57 (37.5%) patients. The hyperintense group showed a higher ORR (36.8% vs. 22.1%) and comparable PFS (8.9 vs. 7.9 months) and OS (16.7 vs. 23.9 months), though not statistically significant. The TtPR was significantly shorter in the hyperintense group (median 26.0 months vs. not reached, p = 0.033), although mainly influenced by prior systemic therapy. Overall, hyperintense lesions were not associated with reduced efficacy and tended to show more favorable responses.
[CONCLUSION] This prospective multicenter study demonstrates that hepatobiliary hyperintensity on Gd-EOB-DTPA-enhanced MRI-an imaging surrogate of Wnt/β-catenin activation-does not indicate resistance to atezolizumab plus bevacizumab. These findings support the use of combination immunotherapy in molecularly "immune-cold" HCC.
[METHODS] This multicenter prospective study enrolled 152 patients with unresectable HCC treated with atezolizumab plus bevacizumab across 12 Japanese centers. All had Child-Pugh class A liver function and underwent Gd-EOB-DTPA-MRI prior to treatment. Hyperintensity was defined as a relative enhancement ratio ≥ 0.9. Treatment outcomes, including objective response rate (ORR), progression-free survival (PFS), overall survival (OS), and time to partial response (TtPR), were compared between patients with and without hyperintense nodules.
[RESULTS] Of the 152 patients, 82 received immunotherapy as the first-line and 70 as a later-line therapy. Hyperintense nodules were identified in 57 (37.5%) patients. The hyperintense group showed a higher ORR (36.8% vs. 22.1%) and comparable PFS (8.9 vs. 7.9 months) and OS (16.7 vs. 23.9 months), though not statistically significant. The TtPR was significantly shorter in the hyperintense group (median 26.0 months vs. not reached, p = 0.033), although mainly influenced by prior systemic therapy. Overall, hyperintense lesions were not associated with reduced efficacy and tended to show more favorable responses.
[CONCLUSION] This prospective multicenter study demonstrates that hepatobiliary hyperintensity on Gd-EOB-DTPA-enhanced MRI-an imaging surrogate of Wnt/β-catenin activation-does not indicate resistance to atezolizumab plus bevacizumab. These findings support the use of combination immunotherapy in molecularly "immune-cold" HCC.
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