Title: Hyperprogressive disease during atezolizumab plus bevacizumab treatment in patients
with advanced hepatocellular carcinoma from Japanese real-world practice
Version: 5 Date: 13 Feb 2023
Reviewer's report:
Many of my previous comments have been suitably addressed, whereas a few points still remain
that need to be clarified.
Major:
- Regarding the patients who received effective treatments (mainly lenvatinib) during the
reference period: I am not fully convinced that these patients can be included in the analysis.
Although I appreciate your effort to discuss it as a limitation of the study, it remains questionable
to me if the treatment might have slowed down the tumor progression in the reference period
to a degree that can not be quantified, hence possibly distorting the difference of tumor growth
between reference and experimental period (which defines "hyperprogression"). At the moment,
I do not see any data or analysis within the manuscript that is able to convincingly refute this
concern.
Minor:
- The sentence "Third, we discovered a few advanced HCC patients with HPD treated by Atez/
Bev in our cohort (twofold: 8 patients, fourfold: 5 patients)." in the Discussion section of the
manuscript is not fully clear to me. Please rephrase.
Title: Hyperprogressive disease during atezolizumab plus bevacizumab treatment in patients
with advanced hepatocellular carcinoma from Japanese real-world practice
Version: 5 Date: 13 Feb 2023
Reviewer's report:
Many of my previous comments have been suitably addressed, whereas a few points still remain
that need to be clarified.
Major:
- Regarding the patients who received effective treatments (mainly lenvatinib) during the
reference period: I am not fully convinced that these patients can be included in the analysis.
Although I appreciate your effort to discuss it as a limitation of the study, it remains questionable
to me if the treatment might have slowed down the tumor progression in the reference period
to a degree that can not be quantified, hence possibly distorting the difference of tumor growth
between reference and experimental period (which defines "hyperprogression"). At the moment,
I do not see any data or analysis within the manuscript that is able to convincingly refute this
concern.
Minor:
- The sentence "Third, we discovered a few advanced HCC patients with HPD treated by Atez/
Bev in our cohort (twofold: 8 patients, fourfold: 5 patients)." in the Discussion section of the
manuscript is not fully clear to me. Please rephrase.
Please review this paper.
user
Title: Hyperprogressive disease during atezolizumab plus bevacizumab treatment in patients
with advanced hepatocellular carcinoma from Japanese real-world practice
Version: 5 Date: 13 Feb 2023
Reviewer's report:
Many of my previous comments have been suitably addressed, whereas a few points still remain
that need to be clarified.
Major:
- Regarding the patients who received effective treatments (mainly lenvatinib) during the
reference period: I am not fully convinced that these patients can be included in the analysis.
Although I appreciate your effort to discuss it as a limitation of the study, it remains questionable
to me if the treatment might have slowed down the tumor progression in the reference period
to a degree that can not be quantified, hence possibly distorting the difference of tumor growth
between reference and experimental period (which defines "hyperprogression"). At the moment,
I do not see any data or analysis within the manuscript that is able to convincingly refute this
concern.
Minor:
- The sentence "Third, we discovered a few advanced HCC patients with HPD treated by Atez/
Bev in our cohort (twofold: 8 patients, fourfold: 5 patients)." in the Discussion section of the
manuscript is not fully clear to me. Please rephrase.
assistant