Han Ji Won, Sung Pil Soo, Yoo Jae-Sung, Cho Hee Sun, Lee Soon Kyu, Yang Hyun, Kim Ji Hoon, Nam Heechul, Lee Hae Lim, Kim Hee Yeon, Lee Sung Won, Song Do Seon, Song Myeong Jun, Kwon Jung Hyun, Kim Chang Wook, Bae Si Hyun, Jang Jeong Won, Choi Jong Young, Yoon Seung Kew
The Catholic University Liver Research Center, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
Front Oncol. 2024 Feb 28;14:1372007. doi: 10.3389/fonc.2024.1372007. eCollection 2024.
Atezolizumab+bevacizumab (AB) and lenvatinib have been proposed as first-line treatment options for patients with advanced hepatocellular carcinoma (HCC), but comparative efficacy and associated factors are controversial.
This real-world multicenter study analysed patients with HCC who received AB (n=169) or lenvatinib (n=177).
First, 1:1 propensity score matching (PSM) was performed, resulting in 141 patients in both the AB and lenvatinib groups. After PSM, overall survival (OS) was better in the AB group than in the lenvatinib group [hazard ratio (HR)=0.642, P=0.009], but progression-free survival (PFS) did not vary between the two groups (HR=0.817, P=0.132). Objective response rate (ORR) was also similar between AB and lenvatinib (34.8% vs. 30.8%, P=0.581). In a subgroup of patients with objective responses (OR, n=78), OS (HR=0.364, P=0.012) and PFS (HR=0.536, P=0.019) were better in the AB group (n=41) than in the lenvatinib group (n=37). Time-to-progression from time of OR was also better in the AB group (HR=0.465, P=0.012). Importantly, residual liver function was a significant factor related to OS in both treatments. Child-Pugh score following cessation of the respective treatments was better in the AB group (n=105) than in the lenvatinib group (n=126) (median 6 versus 7, P=0.008), and proportion of salvage treatment was also higher in the AB group (52.4% versus 38.9%, P=0.047). When we adjusted for residual liver function or salvage treatment, there was no difference in OS between the two treatments.
Our study suggests that residual liver function and subsequent salvage treatments are major determinants of clinical outcomes in patients treated with AB and lenvatinib; these factors should be considered in future comparative studies.
阿替利珠单抗联合贝伐单抗（AB）和乐伐替尼已被提议作为晚期肝细胞癌（HCC）患者的一线治疗选择，但比较疗效及相关因素仍存在争议。
这项真实世界的多中心研究分析了接受AB治疗（n = 169）或乐伐替尼治疗（n = 177）的HCC患者。
首先，进行了1:1倾向评分匹配（PSM），AB组和乐伐替尼组各有141例患者。PSM后，AB组的总生存期（OS）优于乐伐替尼组[风险比（HR）= 0.642，P = 0.009]，但两组的无进展生存期（PFS）无差异（HR = 0.817，P = 0.132）。AB组和乐伐替尼组的客观缓解率（ORR）也相似（34.8%对30.8%，P = 0.581）。在有客观缓解的患者亚组（OR，n = 78）中，AB组（n = 41）的OS（HR = 0.364，P = 0.012）和PFS（HR = 0.536，P = 0.019）优于乐伐替尼组（n = 37）。从OR时间开始的至进展时间在AB组也更好（HR = 0.465，P = 0.012）。重要的是，残余肝功能是两种治疗中与OS相关的重要因素。各自治疗停止后的Child-Pugh评分在AB组（n = 105）中优于乐伐替尼组（n = 126）（中位数分别为6和7，P = 0.008），AB组的挽救治疗比例也更高（52.4%对38.9%，P = 0.047）。当我们对残余肝功能或挽救治疗进行校正后，两种治疗的OS无差异。
我们的研究表明，残余肝功能和后续挽救治疗是接受AB和乐伐替尼治疗患者临床结局的主要决定因素；在未来的比较研究中应考虑这些因素。
