Does first-line treatment have prognostic impact for unresectable HCC?-Atezolizumab plus bevacizumab versus lenvatinib

被引：31

作者：

Hiraoka, Atsushi ^{[1
]}

Kumada, Takashi ^{[2
]}

Tada, Toshifumi ^{[3
]}

Hirooka, Masashi ^{[4
]}

Kariyama, Kazuya ^{[5
]}

Tani, Joji ^{[6
]}

Atsukawa, Masanori ^{[7
]}

Takaguchi, Koichi ^{[8
]}

Itobayashi, Ei ^{[9
]}

Fukunishi, Shinya ^{[10
]}

Tsuji, Kunihiko ^{[11
]}

Ishikawa, Toru ^{[12
]}

Tajiri, Kazuto ^{[13
]}

Ochi, Hironori ^{[14
]}

Yasuda, Satoshi ^{[15
]}

Toyoda, Hidenori ^{[15
]}

Ogawa, Chikara ^{[16
]}

Nishimura, Takashi ^{[17
]}

Hatanaka, Takeshi ^{[18
]}

Kakizaki, Satoru ^{[19
]}

Shimada, Noritomo ^{[20
]}

Kawata, Kazuhito ^{[21
]}

Naganuma, Atsushi ^{[22
]}

Kosaka, Hisashi ^{[23
]}

Shibata, Hiroshi ^{[24
]}

Aoki, Tomoko ^{[25
]}

Tanaka, Takaaki ^{[1
]}

Ohama, Hideko ^{[1
,10
]}

Nouso, Kazuhiro ^{[5
]}

Morishita, Asahiro ^{[6
]}

Tsutsui, Akemi ^{[7
]}

Nagano, Takuya ^{[8
]}

Itokawa, Norio ^{[7
]}

Okubo, Tomomi ^{[7
]}

Arai, Taeang ^{[7
]}

Imai, Michitaka ^{[12
]}

Koizumi, Yohei ^{[4
]}

Nakamura, Shinichiro ^{[3
]}

Joko, Kouji ^{[14
]}

Iijima, Hiroko ^{[17
]}

Kaibori, Masaki ^{[23
]}

Hiasa, Yoichi ^{[4
]}

Kudo, Masatoshi ^{[25
]}

机构：

[1] Ehime Prefectural Cent Hosp, Gastroenterol Ctr, 83 Kasuga Cho, Matsuyama, Ehime 7900024, Japan

[2] Gifu Kyoritsu Univ, Dept Nursing, Ogaki, Japan

[3] Japanese Red Cross Himeji Hosp, Dept Internal Med, Himeji, Hyogo, Japan

[4] Ehime Univ, Dept Gastroenterol & Metabol, Grad Sch Med, Toon, Japan

[5] Okayama City Hosp, Dept Gastroenterol, Okayama, Japan

[6] Kagawa Univ, Dept Gastroenterol & Hepatol, Takamatsu, Kagawa, Japan

[7] Nippon Med Sch, Div Gastroenterol & Hepatol, Dept Internal Med, Tokyo, Japan

[8] Kagawa Prefectural Cent Hosp, Dept Hepatol, Takamatsu, Kagawa, Japan

[9] Asahi Gen Hosp, Dept Gastroenterol, Asahi, Japan

[10] Osaka Med & Phamaceut Univ, Dept Gastroenterol, Osaka, Japan

[11] Teine Keijinkai Hosp, Ctr Gastroenterol, Sapporo, Hokkaido, Japan

[12] Saiseikai Niigata Hosp, Dept Gastroenterol, Niigata, Japan

[13] Toyama Univ Hosp, Dept Gastroenterol, Toyama, Japan

[14] Japanese Red Cross Matsuyama Hosp, Hepatobiliary Ctr, Matsuyama, Ehime, Japan

[15] Ogaki Municipal Hosp, Dept Gastroenterol & Hepatol, Ogaki, Japan

[16] Japanese Red Cross Takamatsu Hosp, Dept Gastroenterol, Takamatsu, Kagawa, Japan

[17] Hyogo Coll Med, Dept Gastroenterol & Hepatol, Nishinomiya, Hyogo, Japan

[18] Gunma Saiseikai Maebashi Hosp, Dept Gastroenterol, Gunma, Japan

[19] Natl Hosp Org Takasaki Gen Med Ctr, Dept Clin Res, Takasaki, Gumma, Japan

[20] Otakanomori Hosp, Div Gastroenterol & Hepatol, Kashiwa, Chiba, Japan

[21] Hamamatsu Univ Sch Med, Hepatol Div, Dept Internal Med 2, Hamamatsu, Shizuoka, Japan

[22] Natl Hosp Org Takasaki Gen Med Ctr, Dept Gastroenterol, Takasaki, Gumma, Japan

[23] Kansai Med Univ, Dept Surg, Hirakata, Osaka, Japan

[24] Tokushima Prefectural Cent Hosp, Dept Gastroenterol, Tokushima, Japan

[25] Kindai Univ, Dept Gastroenterol & Hepatol, Fac Med, Osaka, Japan

来源：

CANCER MEDICINE | 2023年 / 12卷 / 01期

关键词：

atezolizumab plus bevacizumab; hepatocellular carcinoma; lenvatinib; prognosis; ADVANCED HEPATOCELLULAR-CARCINOMA; POST-PROGRESSION SURVIVAL; ALBUMIN-BILIRUBIN GRADE; INVERSE PROBABILITY; SORAFENIB; MANAGEMENT;

D O I：

10.1002/cam4.4854

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Background/Aim A comparison of therapeutic efficacy between atezolizumab plus bevacizumab (Atez/Bev) and lenvatinib treatment given as first-line therapy for unresectable hepatocellular carcinoma (u-HCC) in regard to progression-free survival (PFS) overall survival (OS) has not been reported. We aimed to elucidate which of those given as initial treatment for u-HCC has greater prognostic impact on PFS and OS of affected patients, retrospectively. Materials/Methods From 2020 to January 2022, 251 u-HCC (Child-Pugh A, ECOG PS 0/1, BCLC-B/C) treated were enrolled (Atez/Bev-group, n = 194; lenvatinib-group, n = 57). PFS and OS were analyzed following adjustment based on inverse probability weighting (IPW). Results There was a greater number of patients with macro-vascular invasion in Atez/Bev-group (22.7% vs. 8.8%, p = 0.022). In lenvatinib-group, the frequencies of appetite loss (38.6% vs. 19.6%, p = 0.002), hypothyroidism (21.1% vs. 6.7%, p = 0.004), hand foot skin reaction (19.3% vs. 1.0%, p < 0.001), and diarrhea (10.5% vs. 4.6%, p = 0.012) were greater, while that of general fatigue was lower (22.8% vs. 26.3%, p = 0.008). Comparisons of therapeutic best response using modified response evaluation criteria in solid tumors (mRECIST) did not show significant differences between the present groups (Atez/Bev vs. lenvatinib: CR/PR/SD/PD = 6.1%/39.1%/39.1%/15.6% vs. 0%/48.0%/38.0%/14.0%, p = 0.285). In patients of discontinuation of treatments, 48.2% switched to lenvatinib, 10.6% continued beyond PD, 8.2% received another systemic treatment, 5.9% underwent transcatheter arterial chemoembolization (TACE), 3.5% received hepatic arterial infusion chemotherapy (HAIC), and 1.2% underwent surgical resection in Atez/Bev-group, while 42.2% switched to Atez/Bev, 4.4% continued beyond PD, 4.4% received another systemic treatment, 2.2% nivolumab, 6.7% received TACE, and 2.2% received HAIC in lenvatinib-group. Following adjustment with inverse probability weighting (IPW), Atez/Bev-group showed better PFS (0.5-/1-/1.5-years: 56.6%/31.6%/non-estimable vs. 48.6%/20.4%/11.2%, p < 0.0001) and OS rates (0.5-/1-/1.5-years: 89.6%/67.2%/58.1% vs. 77.8%/66.2%/52.7%, p = 0.002). Conclusion The present study showed that u-HCC patients who received Atez/Bev as a first-line treatment may have a better prognosis than those who received lenvatinib.

引用

页码：325 / 334

页数：10

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