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. 2024 Oct 12;16(20):3458.
doi: 10.3390/cancers16203458.

Comparing Lenvatinib/Pembrolizumab with Atezolizumab/Bevacizumab in Unresectable Hepatocellular Carcinoma: A Real-World Experience with Propensity Score Matching Analysis

Yu-Chun Hsu  1   2 , Po-Ting Lin  1   2   3 , Wei Teng  1   2 , Yi-Chung Hsieh  1   2 , Wei-Ting Chen  1   2 , Chung-Wei Su  1   2 , Ching-Ting Wang  2   4 , Pei-Mei Chai  2   4 , Chen-Chun Lin  2   5 , Chun-Yen Lin  1   2 , Shi-Ming Lin  1   2
Affiliations

Comparing Lenvatinib/Pembrolizumab with Atezolizumab/Bevacizumab in Unresectable Hepatocellular Carcinoma: A Real-World Experience with Propensity Score Matching Analysis

Yu-Chun Hsu et al. Cancers (Basel). .

Abstract

Background: The combination of anti-angiogenic therapy and immune checkpoint inhibitors has revolutionized the management of unresectable hepatocellular carcinoma (uHCC). While an early-phase study demonstrated promising outcomes for lenvatinib plus pembrolizumab (L+P) in treating uHCC, the LEAP-002 trial did not meet its primary endpoint. However, the comparative efficacy between L+P and atezolizumab plus bevacizumab (A+B) as first-line treatment remains a topic of uncertainty. This study aimed to assess the effectiveness and safety of L+P in contrast to A+B among patients diagnosed with uHCC.

Methods: We conducted a retrospective analysis of enrolled patients with uHCC who received L+P or A+B as initial systemic treatment at Chang Gung Memorial Hospital from June 2019 to December 2022. The overall survival (OS), progression-free survival (PFS), objective response rate (ORR), and disease control rate (DCR) by modified RECIST were compared.

Results: 121 patients were recruited, with 37 receiving L+P and 84 receiving A+B. Among them, 95 (78.5%) patients were BCLC stage C, and 99 (81.8%) patients had viral etiology for HCC, predominantly chronic HBV (68.6%). Both the L+P and the A+B groups demonstrated comparable OS (18.2 months versus 14.6 months, p = 0.35) and PFS (7.3 months versus 8.9 months, p = 0.75). The ORR and DCR were similar. After propensity score matching, the results remained consistent between the matched patients. Treatment-related adverse events of any grade occurred in 30 (81.1%) in the L+P group and 62 (73.8%) in the A+B group.

Conclusions: Our findings suggest that L+P and A+B exhibit comparable efficacy and safety profiles in real-world settings.

Keywords: atezolizumab; bevacizumab; hepatocellular carcinoma (HCC); lenvatinib; pembrolizumab.

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Conflict of interest statement

Yu-Chun Hsu, Po-Ting Lin, Wei Teng, Yi-Chung Hsieh, Wei-Ting Chen, Chung-Wei Su, Ching-Ting Wang, Pei-Mei Chai, Chen-Chun Lin, Chun-Yen Lin, Shi-Ming Lin declare that they have no conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of the study design.
Figure 2
Figure 2
Kaplan–Meier curves of (a) overall survival (OS) of the entire cohort; (b) progression-free survival (PFS) of the entire cohort; (c) OS of the matched cohort; (d) PFS of the matched cohort; (e) OS of the patients having AFP level > 400 ng/mL at baseline; (f) PFS of the patients having AFP level > 400 ng/mL at baseline; (g) OS of the patients having intrahepatic tumor burden beyond the eleven-criteria; (h) PFS of patients having intrahepatic tumor burden beyond the eleven-criteria.
See this image and copyright information in PMC

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