Huang Lichang, Xu Yujie, Liu Na, Chen Hailong, Wu Zichao, Li Qijiong, Lu Minqiang, Wei Wei, Zhang Yaojun, Chen Minshan, Xu Li, Shi Ming, Lai Zhicheng
Department of Hepatobiliary Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China.
Department of Hepatobiliary Pancreatic Surgery, Guangzhou First People's Hospital, Guangzhou, Guangdong, China.
Front Immunol. 2025 May 23;16:1573098. doi: 10.3389/fimmu.2025.1573098. eCollection 2025.
The combination of anti-angiogenic agents, PD-1/L1 inhibitors, and hepatic arterial infusion chemotherapy (HAIC) has emerged as an important strategy for unresectable hepatocellular carcinoma (uHCC), yet comparative data on efficacy and safety between different anti-angiogenic agents (lenvatinib [LenHAP] or bevacizumab [BevHAP]) remain lacking, especially in patients with potential resectable features (PotenR).
This retrospective study included patients from 3 hospitals. Included patients received LenHAP or BevHAP as the first-line treatment. The overall survival (OS), progression-free survival (PFS), objective response rate (ORR), conversion resection rate (CRR) and adverse events (AE) were compared.
We included 108 uHCC patients in each group after propensity score matching (PSM), of which PotenR patients accounted for 34.3%. Compared with BevHAP group, the LenHAP group demonstrated significantly prolonged median PFS (12.6 8.1 months; HR, 0.64; 95% CI, 0.46-0.90; =0.0085), with a trend toward improved OS (26.4 19.6 months; HR, 0.71; 95% CI, 0.41-1.1; =0.091). PotenR patients receiving LenHAP achieved superior outcomes, including markedly extended OS (both not reached in median, =0.018), PFS (19.8 11.5, months, =0.0067), and higher conversion resection rates (52.6% 25.0%, =0.015). Both regimens showed comparable safety profiles, with similar frequencies of grade 3-4 adverse events (47.2% 39.8%, =0.27) and serious adverse events (4.6% 8.3%, =0.27).
LenHAP might offer enhanced clinical benefits over BevHAP in uHCC, particularly for PotenR patients, while maintaining equivalent tolerability.
抗血管生成药物、PD-1/L1抑制剂和肝动脉灌注化疗（HAIC）联合应用已成为不可切除肝细胞癌（uHCC）的重要治疗策略，但不同抗血管生成药物（乐伐替尼[LenHAP]或贝伐单抗[BevHAP]）之间在疗效和安全性方面的比较数据仍然缺乏，尤其是在具有潜在可切除特征（PotenR）的患者中。
这项回顾性研究纳入了来自3家医院的患者。纳入的患者接受LenHAP或BevHAP作为一线治疗。比较总生存期（OS）、无进展生存期（PFS）、客观缓解率（ORR）、转化切除率（CRR）和不良事件（AE）。
倾向评分匹配（PSM）后，每组纳入108例uHCC患者，其中PotenR患者占34.3%。与BevHAP组相比，LenHAP组的中位PFS显著延长（12.6对8.1个月；HR，0.64；95%CI，0.46-0.90；P=0.0085），OS有改善趋势（26.4对19.6个月；HR，0.71；95%CI，0.41-1.1；P=0.091）。接受LenHAP治疗的PotenR患者取得了更好的结果，包括显著延长的OS（中位均未达到，P=0.018）、PFS（19.8对11.5个月，P=0.0067）和更高的转化切除率（52.6%对25.0%，P=0.015）。两种治疗方案的安全性相当，3-4级不良事件（47.2%对39.8%，P=0.27）和严重不良事件（4.6%对8.3%，P=0.27）的发生频率相似。
在uHCC中，LenHAP可能比BevHAP带来更大的临床益处，特别是对于PotenR患者，同时保持相当的耐受性。
