Real-world outcomes of combination immunotherapy in patients with Child–Pugh class B hepatocellular carcinoma.

556 Background: Systemic therapy for hepatocellular carcinoma (HCC) is primarily recommended for patients with preserved liver function (Child–Pugh A, CP-A). Evidence in Child–Pugh B (CP-B) remains scarce. We evaluated real-world outcomes of atezolizumab plus bevacizumab (Atezo+Bev) and durvalumab plus tremelimumab (Dur+Tre) in patients with CP-B. Methods: We retrospectively analyzed 222 patients with unresectable HCC treated with Atezo+Bev or Dur+Tre. Tumor response was assessed by RECIST v1.1 and safety by CTCAE v5.0. Outcomes included overall survival (OS), progression-free survival (PFS), objective response rate (ORR), disease control rate (DCR), treatment discontinuation, and subsequent therapy. Results: With Atezo+Bev, median PFS was 6.0 months in CP-A (n=149) and 7.1 months in CP-B (n=23), and median OS was 23.8 vs 8.5 months. With Dur+Tre, median PFS was 2.8 months in CP-A (n=38) and 1.8 months in CP-B (n=12), with OS not reached in CP-A vs 3.9 months in CP-B. In CP-B patients, ORR was 10.5% with Atezo+Bev and 0% with Dur+Tre; DCR was 63.2% and 40.0%, respectively. PFS in CP-B patients was comparable to CP-A, but OS was shorter. Transition to subsequent therapy was less frequent in CP-B than CP-A with Atezo+Bev (47.6% vs 77.6%, p