Differential liver function at cessation of atezolizumab-bevacizumab versus lenvatinib in HCC: a multicenter, propensity-score matched comparative study

Ji Won Han, Pil Soo Sung, Jae Sung Yoo, Hee Sun Cho, Soon Kyu Lee, Hyun Yang, Ji Hoon Kim, Heechul Nam, Hae Lim Lee, Hee Yeon Kim, Sung Won Lee, Do Seon Song, Myeong Jun Song, Jung Hyun Kwon, Chang Wook Kim, Si Hyun Bae, Jeong Won Jang, Jong Young Choi, Seung Kew Yoon

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Atezolizumab+bevacizumab (AB) and lenvatinib have been proposed as first-line treatment options for patients with advanced hepatocellular carcinoma (HCC), but comparative efficacy and associated factors are controversial. Materials and methods: This real-world multicenter study analysed patients with HCC who received AB (n=169) or lenvatinib (n=177). Results: First, 1:1 propensity score matching (PSM) was performed, resulting in 141 patients in both the AB and lenvatinib groups. After PSM, overall survival (OS) was better in the AB group than in the lenvatinib group [hazard ratio (HR)=0.642, P=0.009], but progression-free survival (PFS) did not vary between the two groups (HR=0.817, P=0.132). Objective response rate (ORR) was also similar between AB and lenvatinib (34.8% vs. 30.8%, P=0.581). In a subgroup of patients with objective responses (OR, n=78), OS (HR=0.364, P=0.012) and PFS (HR=0.536, P=0.019) were better in the AB group (n=41) than in the lenvatinib group (n=37). Time-to-progression from time of OR was also better in the AB group (HR=0.465, P=0.012). Importantly, residual liver function was a significant factor related to OS in both treatments. Child-Pugh score following cessation of the respective treatments was better in the AB group (n=105) than in the lenvatinib group (n=126) (median 6 versus 7, P=0.008), and proportion of salvage treatment was also higher in the AB group (52.4% versus 38.9%, P=0.047). When we adjusted for residual liver function or salvage treatment, there was no difference in OS between the two treatments. Conclusion: Our study suggests that residual liver function and subsequent salvage treatments are major determinants of clinical outcomes in patients treated with AB and lenvatinib; these factors should be considered in future comparative studies.

Original languageEnglish
Article number1372007
JournalFrontiers in Oncology
Volume14
DOIs
StatePublished - 2024

Bibliographical note

Publisher Copyright:
Copyright © 2024 Han, Sung, Yoo, Cho, Lee, Yang, Kim, Nam, Lee, Kim, Lee, Song, Song, Kwon, Kim, Bae, Jang, Choi and Yoon.

Keywords

  • atezolizumab plus bevacizumab
  • HCC
  • lenvatinib
  • residual liver function
  • survival

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