仑伐替尼对比阿替利珠单抗联合贝伐珠单抗一线治疗不可切除肝细胞癌的真实世界研究的荟萃分析。

Lenvatinib Versus Atezolizumab Plus Bevacizumab in the First-Line Treatment for Unresectable Hepatocellular Carcinoma: A Meta-Analysis of Real-World Studies.

机构信息

Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China.

Department of Oncology, The Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, China.

出版信息

Target Oncol. 2024 Mar;19(2):203-212. doi: 10.1007/s11523-024-01035-2. Epub 2024 Jan 30.

DOI:10.1007/s11523-024-01035-2

PMID:38289445

Abstract

BACKGROUND

Immunotherapy has revolutionized the treatment of hepatocellular carcinoma (HCC). However, whether adding immunotherapy to antiangiogenic therapy benefits patients with unresectable HCC (uHCC) more in the first-line setting remains controversial.

OBJECTIVE

In this analysis, we compared the clinical outcomes of lenvatinib monotherapy with atezolizumab plus bevacizumab combination therapy in advanced uHCC in real-world clinical practice.

METHODS

The MEDLINE, Embase, and Cochrane CENTRAL databases were systematically searched on 23 April 2023. The "metaSurvival" and "meta" packages of the R software (version 4.2.2) were used to summarize the survival curves and meta-analyze the survival data. Overall survival (OS) and progression-free survival (PFS) were defined as dual primary endpoints. Secondary endpoints included the objective response rate (ORR) and disease control rate (DCR).

RESULTS

Overall, the pooled median OS was 18.4 months in the lenvatinib group versus 18.5 months in the atezolizumab plus bevacizumab group; the pooled median PFS was 6.9 months in the lenvatinib group versus 7.3 months in the atezolizumab plus bevacizumab group. Lenvatinib therapy showed similar OS [hazard ratio (HR): 0.91, 95% confidence interval (CI): 0.55-1.52, p = 0.72] and PFS (HR: 0.79, 95% CI: 0.56-1.12, p = 0.19) compared with atezolizumab plus bevacizumab therapy. In addition, a comparable ORR [odds ratio (OR): 0.89, 95% CI: 0.65-1.20, p = 0.44) was observed between lenvatinib and atezolizumab plus bevacizumab.

CONCLUSIONS

Comprehensive analysis suggested that lenvatinib monotherapy exhibited survival outcomes comparable to those of atezolizumab plus bevacizumab combination therapy, which may provide useful insights for clinicians in future clinical practice.

摘要

背景

免疫疗法已经彻底改变了肝细胞癌（HCC）的治疗方法。然而，在一线治疗中，将免疫疗法与抗血管生成治疗联合应用是否能使不可切除 HCC（uHCC）患者获益更多，目前仍存在争议。

目的

在这项分析中，我们比较了仑伐替尼单药治疗与阿替利珠单抗联合贝伐珠单抗联合治疗在真实世界临床实践中晚期 uHCC 的临床结局。

方法

我们于 2023 年 4 月 23 日系统检索了 MEDLINE、Embase 和 Cochrane CENTRAL 数据库。使用 R 软件（版本 4.2.2）的“metaSurvival”和“meta”包来总结生存曲线并对生存数据进行荟萃分析。总生存期（OS）和无进展生存期（PFS）被定义为双重主要终点。次要终点包括客观缓解率（ORR）和疾病控制率（DCR）。

结果

总体而言，仑伐替尼组的中位 OS 为 18.4 个月，阿替利珠单抗联合贝伐珠单抗组为 18.5 个月；仑伐替尼组的中位 PFS 为 6.9 个月，阿替利珠单抗联合贝伐珠单抗组为 7.3 个月。仑伐替尼治疗的 OS[风险比（HR）：0.91，95%置信区间（CI）：0.55-1.52，p = 0.72]和 PFS（HR：0.79，95%CI：0.56-1.12，p = 0.19）与阿替利珠单抗联合贝伐珠单抗治疗相似。此外，仑伐替尼与阿替利珠单抗联合贝伐珠单抗治疗的 ORR 也相似[比值比（OR）：0.89，95%CI：0.65-1.20，p = 0.44）。