Atezolizumab plus bevacizumab versus lenvatinib for unresectable hepatocellular carcinoma: a large real-life worldwide population

• DOI: 10.1016/j.ejca.2022.11.017
• Publication Date: 2022-11-25T20:46:18Z
• Authors: Andrea Casadei-Ga...; Margherita Rimini; Toshifumi Tada; Goki Suda; Shigeo Shimose; Masatoshi Kudo; Jaekyung Cheon; Fabian Finkelmeier; Ho Yeong Lim; Lorenza Rimassa; José Presa; Gianluca Masi; Changhoon Yoo; Sara Lonardi; Francesco Tovoli; Takashi Kumada; Naoya Sakamoto; Hideki Iwamoto; Tomoko Aoki; Hong Jae Chon; Vera Himmelsbach; Tiziana Pressiani; Margarida Montes; Caterina Vivaldi; Caterina Soldà; Fabio Piscaglia; Atsushi Hiraoka; Takuya Sho; Takashi Niizeki; Naoshi Nishida; Christoph Steup; Massimo Iavarone; Giovanni Di Costanzo; Fabio Marra; Mario Scartozzi; Emiliano Tamburini; Giuseppe Cabibbo; Francesco Giusepp...; Marianna Silletta; Masashi Hirooka; Kazuya Kariyama; Joji Tani; Masanori Atsukawa; Koichi Takaguchi; Ei Itobayashi; Shinya Fukunishi; Kunihiko Tsuji; Toru Ishikawa; Kazuto Tajiri; Hironori Ochi; Satoshi Yasuda; Hidenori Toyoda; Chikara Ogawa; Takashi Nishimura; Takeshi Hatanaka; Satoru Kakizaki; Noritomo Shimada; Kazuhito Kawata; Fujimasa Tada; Hideko Ohama; Kazuhiro Nouso; Asahiro Morishita; Akemi Tsutsui; Takuya Nagano; Norio Itokawa; Tomomi Okubo; Taeang Arai; Michitaka Imai; Hisashi Kosaka; Atsushi Naganuma; Yohei Koizumi; Shinichiro Nakamura; Masaki Kaibori; Hiroko Iijima; Yoichi Hiasa; Valentina Burgio; Mara Persano; Angelo Della Corte; Francesca Ratti; Francesco De Cobelli; Luca Aldrighetti; Stefano Cascinu; Alessandro Cucchetti
• Keywords: 0301 basic medicine; Carcinoma, Hepatocellular; Liver Neoplasms; NASH; 3. Good health; Advanced HCC; Atezolizumab; Bevacizumab; Lenvatinib; NAFLD; NASH; RWD; Bevacizumab; Advanced HCC, Atezolizumab, Bevacizumab, Lenvatinib, NAFLD, NASH, RWD.; 03 medical and health sciences; RWD; Advanced HCC; Non-alcoholic Fatty Liver Disease; NAFLD; Lenvatinib; Humans; Atezolizumab

Atezolizumab plus bevacizumab and lenvatinib have not been compared in a randomised controlled trial. We conducted a retrospective multi-centre study to compare the clinical efficacy and safety of lenvatinib and atezolizumab with bevacizumab as a first-line treatment for patients with unresectable HCC in the real-world scenario.Clinical features of lenvatinib and atezolizumab plus bevacizumab patients were balanced through inverse probability of treatment weighting (IPTW) methodology, which weights patients' characteristics and measured outcomes of each patient in both treatment arms. Overall survival (OS) was the primary end-point.The analysis included 1341 patients who received lenvatinib, and 864 patients who received atezolizumab plus bevacizumab. After IPTW adjustment, atezolizumab plus bevacizumab did not show a survival advantage over lenvatinib HR 0.97 (p = 0.739). OS was prolonged by atezolizumab plus bevacizumab over lenvatinib in viral patients (HR: 0.76; p = 0.024). Conversely, OS was prolonged by lenvatinib in patients with non-alcoholic steatohepatitis/non-alcoholic fatty liver disease (HR: 1.88; p = 0.014). In the IPTW-adjusted population, atezolizumab plus bevacizumab provided better safety profile for most of the recorded adverse events.Our study did not identify any meaningful difference in OS between atezolizumab plus bevacizumab and lenvatinib. Although some hints are provided suggesting that patients with non-alcoholic steatohepatitis/non-alcoholic fatty liver disease might benefit more from lenvatinib therapy and patients with viral aetiology more from atezolizumab plus bevacizumab.