J Liver Cancer.  2024 Mar;24(1):81-91. 10.17998/jlc.2023.12.25.

Comparison of atezolizumab plus bevacizumab and lenvatinib for hepatocellular carcinoma with portal vein tumor thrombosis

• Park J
• Lee YB
• Ko Y
• Park Y
• Shin H
• Hur MH
• Park MK
• Lee DW
• Cho EJ
• Lee KH
• Lee JH
• Yu SJ
• Kim TY
• Kim YJ
• Kim TY
• Yoon JH

• KMID: 2553820
• DOI: http://doi.org/10.17998/jlc.2023.12.25

Abstract

Background
/Aim: Atezolizumab plus bevacizumab and lenvatinib are currently available as first-line therapy for the treatment of unresectable hepatocellular carcinoma (HCC). However, comparative efficacy studies are still limited. This study aimed to investigate the effectiveness of these treatments in HCC patients with portal vein tumor thrombosis (PVTT).
Methods
We retrospectively included patients who received either atezolizumab plus bevacizumab or lenvatinib as first-line systemic therapy for HCC with PVTT. Primary endpoint was overall survival (OS), and secondary endpoints included progressionfree survival (PFS) and disease control rate (DCR) determined by response evaluation criteria in solid tumors, version 1.1.
Results
A total of 52 patients were included: 30 received atezolizumab plus bevacizumab and 22 received lenvatinib. The median follow-up duration was 6.4 months (interquartile range, 3.9-9.8). The median OS was 10.8 months (95% confidence interval [CI], 5.7 to not estimated) with atezolizumab plus bevacizumab and 5.8 months (95% CI, 4.8 to not estimated) with lenvatinib (P=0.26 by log-rank test). There was no statistically significant difference in OS (adjusted hazard ratio [aHR], 0.71; 95% CI, 0.34-1.49; P=0.37). The median PFS was similar (P=0.63 by log-rank test), with 4.1 months (95% CI, 3.3-7.7) for atezolizumab plus bevacizumab and 4.3 months (95% CI, 2.6-5.8) for lenvatinib (aHR, 0.93; 95% CI, 0.51-1.69; P=0.80). HRs were similar after inverse probability treatment weighting. The DCRs were 23.3% and 18.2% in patients receiving atezolizumab plus bevacizumab and lenvatinib, respectively (P=0.74).
Conclusion
The effectiveness of atezolizumab plus bevacizumab and lenvatinib was comparable for the treatment of HCC with PVTT.

Keyword

Liver neoplasms; Immunotherapy; Immune checkpoint inhibitors; PD-L1; Survival

Figure

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  Figure 1. Flow diagram of patient selection for the study. HCC, hepatocellular carcinoma; PVTT, portal vein tumor thrombosis.

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  Figure 2. Kaplan-Meier estimates of OS according to the treatment group (A) before and (B) after IPTW. Propensity scores of inverse probability of treatment weighting were computed using age, sex, the presence or absence of liver cirrhosis, esophageal or gastric varices, fibrosis- 4 index, Child-Pugh score, serum levels of alpha-fetoprotein and protein induced by vitamin K absence or antagonist-II, the extent of portal vein tumor thrombosis, the presence or absence of hepatic vein invasion of hepatocellular carcinoma, and the presence or absence of lymph node or extrahepatic metastasis. Atezo + bev, atezolizumab plus bevacizumab; OS, overall survival; IPTW, inverse probability of treatment weighting.

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  Figure 3. Kaplan-Meier estimates of PFS according to the treatment group (A) before and (B) after IPTW. Propensity scores of inverse probability of treatment weighting were computed using age, sex, the presence or absence of liver cirrhosis, esophageal or gastric varices, fibrosis-4 index, Child-Pugh score, serum levels of alpha-fetoprotein and protein induced by vitamin K absence or antagonist-II, the extent of portal vein tumor thrombosis, the presence or absence of hepatic vein invasion of hepatocellular carcinoma, and the presence or absence of lymph node or extrahepatic metastasis. Atezo + bev, atezolizumab plus bevacizumab; PFS, progression-free survival; IPTW, inverse probability of treatment weighting.

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Reference

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