Kato Daisuke, Suzuki Takanori, Matsuura Kentaro, Okayama Kohei, Okumura Fumihiro, Nagura Yoshihito, Sobue Satoshi, Hayashi Katsumi, Kusakabe Atsunori, Hasegawa Izumi, Matoya Sho, Mizoshita Tsutomu, Kimura Yoshihide, Kondo Hiromu, Ozasa Atsushi, Kawamura Hayato, Fujiwara Kei, Nojiri Shunsuke, Kataoka Hiromi
Department of Gastroenterology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan.
Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Oncology. 2025;103(4):311-319. doi: 10.1159/000541455. Epub 2024 Oct 18.
We investigated the effectiveness of lenvatinib (LEN) after disease progression following first-line treatment with atezolizumab plus bevacizumab (Atez/Bev) in patients with unresectable hepatocellular carcinoma (HCC).
One hundred and ten HCC patients treated with Atez/Bev as first-line systemic chemotherapy were enrolled and underwent dynamic computerized tomography/magnetic resonance imaging to determine the treatment response. We evaluated the treatment efficacy and prognosis after second-line LEN treatment, especially in elderly patients.
Of the 110 study patients, 88 patients (80%) were determined to have progressive disease (PD) during the observation periods, and 40 patients received second-line LEN therapy. The 40 patients included 13 patients who were unable to continue LEN until the initial evaluation due to adverse events (AE). The 27 patients who were able to continue LEN therapy (Group A) were significantly younger at initiation of Atez/Bev than those who could not continue (71 vs. 77 years old, p = 0.013). Comparing the OS and PFS between Group A and 44 patients that included 13 patients who were unable to continue LEN and 31 patients did not receive the second-line treatment (Group B), the former had significantly better OS than Group B (31.1 vs. 17.8 months, p = 0.035).
The tolerability of second-line LEN therapy was lower in elderly patients, and the OS from the start of Atez/Bev therapy was different depending on the tolerability of second-line LEN therapy.
我们研究了在不可切除肝细胞癌（HCC）患者中，一线使用阿替利珠单抗联合贝伐单抗（Atez/Bev）治疗后疾病进展时，乐伐替尼（LEN）的有效性。
110例接受Atez/Bev作为一线全身化疗的HCC患者入组，并接受动态计算机断层扫描/磁共振成像以确定治疗反应。我们评估了二线LEN治疗后的疗效和预后，尤其是老年患者。
在110例研究患者中，88例（80%）在观察期内被确定为疾病进展（PD），40例患者接受了二线LEN治疗。这40例患者中，有13例因不良事件（AE）在初始评估前无法继续使用LEN。能够继续使用LEN治疗的27例患者（A组）在开始使用Atez/Bev时的年龄显著低于无法继续使用的患者（71岁对77岁，p = 0.013）。比较A组与44例患者（包括13例无法继续使用LEN的患者和31例未接受二线治疗的患者，B组）的总生存期（OS）和无进展生存期（PFS），前者的OS显著优于B组（31.1个月对17.8个月，p = 0.035）。
老年患者二线LEN治疗的耐受性较低，从开始Atez/Bev治疗起的OS因二线LEN治疗的耐受性而异。
