Atezolizumab Plus Bevacizumab Versus Lenvatinib for Hepatocellular Carcinoma: A Systematic Review and Meta‐Analysis

Abstract

Hepatocellular carcinoma (HCC) is often diagnosed in advanced stages. Following sorafenib, lenvatinib (LENV) has been approved as a first‐line treatment option for unresectable HCC. In the past few years, at least 9 large‐scale cohort studies have examined the efficacy and safety of LENV compared to atezolizumab plus bevacizumab (ATE/BEV) in unresectable HCC, but there is currently no direct meta‐analysis conducted for a comprehensive consolidation. To provide the most updated meta‐analysis of the clinical efficacy and safety of ATE/BEV versus LENV for patients with unresectable HCC. Our studies comparing the efficacy and safety of ATE/BEV and LENV in unresectable HCC were systematically searched in PubMed, Embase, and Web of Science from inception to February 2023. Outcomes measured were overall survival (OS), progression‐free survival (PFS), mortality, complete response (CR), partial response (PR), objective response rate (ORR), disease control rate (DCR), progressive disease (PD), stable disease (SD), and adverse events (AEs). Seven eligible studies involving 4428 patients (1569 in the ATE/BEV group and 2859 in the LENV group) were included in the narrative synthesis. All baseline characteristics were similar between the 2 groups except for Child‐Pugh class B. Ultimately, our meta‐analysis showed that the LENV group had longer OS and PFS than the ATE/BEV group. Moreover, patients on LENV were more likely to achieve SD, whereas those on ATE/BEV were more likely to achieve PR.

Small molecule tyrosine kinase inhibitors approved for systemic therapy of advanced hepatocellular carcinoma: recent advances and future perspectives

“…The clinical outcomes of atezolizumab plus bevacizumab vs. lenvatinib in patients with unresectable HCC (uHCC) were compared by meta-analyses. Atezolizumab plus bevacizumab resulted in better PFS [ 135 ], comparable OS [ 136 , 137 ] and PFS [ 137 ], or worse OS and PFS [ 136 ] compared with lenvatinib. In non-viral aHCC patients, lenvatinib was associated with signinficantly improved OS and PFS compared to atezolizumab plus bevacizumab [ 138 ], but ORR and DCR were not significantly different in the two treatment groups [ 135 – 137 ].…”