Similar efficacy and safety between lenvatinib versus atezolizumab plus bevacizumab as the first‐line treatment for unresectable hepatocellular carcinoma

Abstract

Background Lenvatinib and atezolizumab plus bevacizumab(A + B) have been used for unresectable hepatocellular carcinoma (HCC) as first‐line therapy. Real‐world studies comparison of efficacy and safety in these two regimens are limited, we therefore conduct this study to investigate these issues. Methods We retrospectively reviewed patients received lenvatinib ( n = 46) and A + B ( n = 46) as first‐line systemic therapy for unresectable HCC in a tertiary medical center. Objective response rate (ORR), progression free survival (PFS), and overall survival (OS) were evaluated according to modified Response Evaluation Criteria in Solid Tumors (mRECIST). Inverse probability weighting (IPW) was performed for baseline clinical features balance. Results A total of 92 patients with median age of 63.8 year‐old, 78.3% male, 85.9% viral hepatitis infected, 67.4% BCLC stage C were enrolled. The median treatment and follow‐up duration were 4.7 months and 9.4 months, respectively. There was no significant difference in ORR (26.1% vs. 41.3%, p = 0.1226), PFS (5.9 vs. 5.3 months, p = 0.4066), and OS (not reached vs. not reached, p = 0.7128) between the lenvatinib and A + B groups. After IPW, the results of survival and response rate were also compared. Subgroup analysis suggested that using lenvatinib was not inferior to A + B in regards of PFS, including those with elder, Child‐Pugh class B, beyond up‐to‐seven, or portal vein invasion VP4 patients. Among the lenvatinib treated patients, multivariate analysis showed patients elder than 65‐year‐old was an independent predictor associated with shorter PFS (adjust HR: 2.085[0.914–4.753], p = 0.0213). The incidence rates of adverse events were similar between two groups (76 vs. 63%, p = 0.1740). Both of two regimens had similarly few impact on liver function by comparison of baseline, third month, and sixth month albumin‐bilirubin index and Child‐Pugh score. Conclusions The efficacy and safety of lenvatinib are similar to A + B as a first‐line systemic therapy for unresectable HCC.

Clinical efficacy and safety of atezolizumab plus bevacizumab versus lenvatinib in the treatment of advanced hepatocellular carcinoma: A systematic review and meta-analysis

“…Some studies suggest that Atez/Bev is more effective than lenvatinib in prolonging patient survival, [9][10][11] while others have reached the opposite conclusion, [12,13] and some people believe that there is no difference in the efficacy of the 2 treatments. [14][15][16] We performed a comprehensive review of relevant literature in this study to assess the clinical efficacy and safety of Atez/Bev versus lenvatinib for the treatment of HCC. We hope our study can provide clinicians with accurate information to guide their decision-making process.…”

“…Some studies suggest that Atez/Bev is more effective than lenvatinib in prolonging patient survival, [9–11] while others have reached the opposite conclusion, [12,13] and some people believe that there is no difference in the efficacy of the 2 treatments. [14–16]…”

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

“…A final total of 7 studies involving 4428 patients (1569 in the ATE/BEV group and 2859 in the LENV group) were included in the meta-analysis. [12][13][14][15][16][17][18] Of the 7 studies, 2 were prospective cohort studies, 14,18 5 were retrospective cohort studies. 12,13,[15][16][17] The characteristics, level of evidence, and quality score of each included study are summarized in Table 1.…”

“…[12][13][14][15][16][17][18] Of the 7 studies, 2 were prospective cohort studies, 14,18 5 were retrospective cohort studies. 12,13,[15][16][17] The characteristics, level of evidence, and quality score of each included study are summarized in Table 1. The median (range) quality score was 7, 12,[14][15][16][17][18] and all studies were identified as high quality.…”

Lenvatinib resistance mechanism and potential ways to conquer

“…Herein, the question of LVN resistance has naturally become a hot topic for scientists to study, no matter in the cancer types of RCC, HCC or DTC ( Hu et al, 2022a ; Persano et al, 2022 ). At present, LVN has achieved good efficacy in the targeted therapy of many cancer types ( Su et al, 2022a ; Wassermann et al, 2022 ). However, in cancer types such as liver cancer, once LVN is resistant to drugs, the drug effect of second-line therapy is often poor ( Jindal et al, 2019 ).…”