阿替利珠单抗联合贝伐单抗与乐伐替尼治疗伴门静脉癌栓的肝细胞癌的比较。
Comparison of atezolizumab plus bevacizumab and lenvatinib for hepatocellular carcinoma with portal vein tumor thrombosis.
作者信息
Park Jeayeon, Lee Yun Bin, Ko Yunmi, Park Youngsu, Shin Hyunjae, Hur Moon Haeng, Park Min Kyung, Lee Dae-Won, Cho Eun Ju, Lee Kyung-Hun, Lee Jeong-Hoon, Yu Su Jong, Kim Tae-Yong, Kim Yoon Jun, Kim Tae-You, Yoon Jung-Hwan
机构信息
Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
出版信息
J Liver Cancer. 2024 Mar;24(1):81-91. doi: 10.17998/jlc.2023.12.25. Epub 2024 Jan 19.
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.
背景/目的：阿替利珠单抗联合贝伐单抗以及乐伐替尼目前均可用作不可切除肝细胞癌（HCC）的一线治疗方案。然而，比较疗效的研究仍然有限。本研究旨在调查这些治疗方案对伴有门静脉肿瘤血栓形成（PVTT）的HCC患者的有效性。
方法
我们回顾性纳入了接受阿替利珠单抗联合贝伐单抗或乐伐替尼作为伴有PVTT的HCC一线全身治疗的患者。主要终点为总生存期（OS），次要终点包括无进展生存期（PFS）以及根据实体瘤疗效评价标准1.1版确定的疾病控制率（DCR）。
结果
共纳入52例患者：30例接受阿替利珠单抗联合贝伐单抗治疗，22例接受乐伐替尼治疗。中位随访时间为6.4个月（四分位间距，3.9 - 9.8）。阿替利珠单抗联合贝伐单抗治疗组的中位OS为10.8个月（95%置信区间[CI]，5.7至未估算），乐伐替尼治疗组为5.8个月（95%CI，4.8至未估算）（对数秩检验P = 0.26）。OS无统计学显著差异（校正风险比[aHR]，0.71；95%CI，0.34 - 1.49；P = 0.37）。中位PFS相似（对数秩检验P = 0.63），阿替利珠单抗联合贝伐单抗治疗组为4.1个月（95%CI，3.3 - 7.7），乐伐替尼治疗组为4.3个月（95%CI，2.6 - 5.8）（aHR，0.93；95%CI，0.51 - 1.69；P = 0.80）。采用逆概率处理加权后风险比相似。接受阿替利珠单抗联合贝伐单抗和乐伐替尼治疗的患者的DCR分别为23.3%和18.2%（P = 0.74）。
结论
阿替利珠单抗联合贝伐单抗和乐伐替尼在治疗伴有PVTT的HCC方面疗效相当。
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