Department of Gastroenterology, Hepatology, Infectiology and Endocrinology, Hannover Medical School, Hannover, Germany.
Department of Gastroenterology, Hepatology and Transplant Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
Hepatol Commun. 2024 Nov 4;8(11). doi: 10.1097/HC9.0000000000000562. eCollection 2024 Nov 1.
Immunotherapy-based combinations are currently the standard of care in the systemic treatment of patients with HCC. Recent studies have reported unexpectedly long survival with lenvatinib (LEN), supporting its use in first-line treatment for HCC. This study aims to compare the real-world effectiveness of LEN to atezolizumab/bevacizumab (AZ/BV).
A retrospective analysis was conducted to evaluate the effectiveness and safety of frontline AZ/BV or LEN therapy in patients with advanced HCC across 18 university hospitals in Europe.
The study included 412 patients (AZ/BV: n=207; LEN: n=205). Baseline characteristics were comparable between the 2 treatment groups. However, patients treated with AZ/BV had a significantly longer median progression-free survival compared to those receiving LEN. The risk of hepatic decompensation was significantly higher in patients with impaired baseline liver function (albumin-bilirubin [ALBI] grade 2) treated with AZ/BV compared to those with preserved liver function. Patients with alcohol-associated liver disease had poorer baseline liver function compared to other etiologies and exhibited a worse outcome under AZ/BV.
In this real-world cohort, survival rates were similar between patients treated with LEN and those treated with AZ/BV, confirming that both are viable first-line options for HCC. The increased risk of hepatic decompensation in patients treated with AZ/BV who have impaired baseline liver function underscores the need for careful monitoring. Future trials should aim to distinguish more clearly between metabolic dysfunction-associated steatotic liver disease and alcohol-associated liver disease.
免疫疗法为基础的联合治疗目前是 HCC 系统治疗的标准治疗方法。最近的研究报告了仑伐替尼（LEN）治疗 HCC 患者的生存时间出人意料地长，支持其在 HCC 一线治疗中的应用。本研究旨在比较 LEN 与阿替利珠单抗/贝伐珠单抗（AZ/BV）在真实世界中的疗效。
对欧洲 18 家大学医院的晚期 HCC 患者进行了一线 AZ/BV 或 LEN 治疗的疗效和安全性的回顾性分析。
本研究纳入了 412 例患者（AZ/BV：n=207；LEN：n=205）。两组患者的基线特征相似。然而，与接受 LEN 治疗的患者相比，接受 AZ/BV 治疗的患者中位无进展生存期显著延长。与肝功能正常（ALBI 分级 2）的患者相比，基线肝功能受损（ALBI 分级 2）的患者接受 AZ/BV 治疗时肝失代偿风险显著增加。与其他病因相比，酒精性肝病患者的基线肝功能较差，在接受 AZ/BV 治疗时预后更差。
在这项真实世界的队列研究中，接受 LEN 治疗的患者与接受 AZ/BV 治疗的患者的生存率相似，证实了 LEN 和 AZ/BV 都是 HCC 的可行一线治疗选择。基线肝功能受损的患者接受 AZ/BV 治疗时肝失代偿风险增加，这突出了需要密切监测。未来的试验应努力更清楚地区分代谢功能障碍相关脂肪性肝病和酒精性肝病。
