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The following is a summary of “Atezolizumab + bevacizumab versus lenvatinib as first-line systemic therapy for treatment of hepatocellular carcinoma in a real-world population: Outcomes from the HCC CHORD database,” published in the 2024 ASCO Annual Meeting under issue of Oncology by Freeman et al.

Lenvatinib (LEN) and atezolizumab with bevacizumab (AB) combination are top treatments for advanced HCC but haven’t been directly compared in trials. Cross-trial comparisons hint at similar survival for AB and LEN, but LEN’s survival was shorter in another trial. 

Researchers conducted a retrospective study comparing LEN and AB directly in a trial for advanced HCC treatment. 

They included patients with HCC, treated with either AB or LEN first-line in certain Canadian provinces, and two centers in Ontario from August 2018 to August 2022. The demographic and clinical data were collected to analyze median OS, PFS, and physician-assessed response rates (RR) for each treatment. 

The results showed that 453 patients received either AB (n=159) or LEN (n=294) as first-line treatment. Most (85%) were male, with 14% having HBV, 32% with HCV, 70% with cirrhosis, 27% BCLC B disease, 69% BCLC C, 37% distant metastasis, 88% Child-Pugh A, 87% ECOG 0-1 performance status and 55% had precious locoregional treatment. Both the groups were balanced in terms of demographic factors. However, patients in the LEN group had a higher incidence of ECOG performance status ≥ 2 (11% vs. 5%, P=0.047), lower incidence of HBV (12% vs. 19%, P=0.047) along with a higher HCV incident rate (36% vs. 25%, P=0.03). Median follow-up time was 9.9 months for AB and 11.8 months for LEN. Median overall survival (mOS) was 15.4 months. For AB, mOS was 19.7 months (95% CI: 14.5 – NR), and for LEN, it was 14.4 months (95% CI: 12.2 – 17.1) (HR 0.72, 95% CI: 0.54-0.95; P=0.021). Median progression-free survival (PFS) was 6.9 months overall, 8.3 months for AB, and 6.3 months for LEN (HR 0.85; 95% CI: 0.68-1.06, P=0.20). RR  was 29% overall, with 31% for AB and 28% for LEN (P=0.50). After AB, 86% received LEN as second-line treatment, while after LEN, 46% received regorafenib, and only 21% received second-line AB.

Investigators concluded that AB showed better overall survival than LEN for first-line HCC treatment in a Western country, though PFS and RR were similar between the two treatments.

Source: meetings.asco.org/abstracts-presentations/234331