| Sorafenib vs. Lenvatinib in advanced hepatocellular carcinoma after Atezolizumab/Bevacizumab Failure: A real-world study |
| Young Eun Chon1, Dong Yun Kim2, Mina Kim2, Beom Kyung Kim2, Seung Up Kim2, Jun Yong Park2, Sang Hoon Ahn2, Yeonjung Ha1, Joo Ho Lee1, Kwan Sik Lee1, Beodeul Kang3, Jung Sun Kim3, Hong Jae Chon3, Do Young Kim2 |
1Department of Gastroenterology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
2Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
3Department of Medical Oncology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea |
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Received: December 21, 2023 Revised: March 1, 2024 Accepted: March 8, 2024
*Young Eun Chon and Dong Yun Kim contributed equally to this work. |
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| ABSTRACT |
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Background
Atezolizumab plus bevacizumab (ATE+BEV) therapy has become the recommended first-line therapy for patients with unresectable hepatocellular carcinoma (HCC) because of favorable treatment responses. However, there is a lack of data on sequential regimens after ATE+BEV treatment failure. We aimed to investigate the clinical outcomes of patients with advanced HCC who received subsequent systemic therapy for disease progression after ATE+BEV.
Methods
This multicenter, retrospective study included patients who started second-line systemic treatment with sorafenib or lenvatinib after HCC progressed on ATE+BEV between August 2019 and December 2022. Treatment response was assessed using the Response Evaluation Criteria in Solid Tumors (version 1.1.). Clinical features of the two groups were balanced through propensity score (PS) matching.
Results
This study enrolled 126 patients, 40 (31.7%) in the lenvatinib group, and 86 (68.3%) in the sorafenib group. The median age was 63 years, and males were predominant (88.1%). In PS-matched cohorts (36 patients in each group), the objective response rate was similar between the lenvatinib- and sorafenib-treated groups (5.6% vs. 8.3%; p=0.643), but the disease control rate was superior in the lenvatinib group (66.7% vs. 22.2%; p<0.001). Despite the superior progression-free survival (PFS) in the lenvatinib group (3.5 vs. 1.8 months, p=0.001), the overall survival (OS, 10.3 vs. 7.5 months, p=0.353) did not differ between the two PS-matched treatment groups.
Conclusion
In second-line therapy for unresectable HCC after ATE+BEV failure, lenvatinib showed better PFS and comparable OS to sorafenib in a real-world setting. Future studies with larger sample sizes and longer follow-ups are needed to optimize second-line treatment. |
| KeyWords:
atezolizumab, bevacizumab, hepatocellular carcinoma, lenvatinib, sorafenib |
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