Organ-specific response with first-line atezolizumab-bevacizumab versus lenvatinib for patients with advanced hepatocellular carcinoma

• Published in: Hepatology international Vol. 18; no. 3; pp. 973 - 983
• Main Authors: Kim, Hyung-Don, Park, Young-Gyu, Kim, Sejin, Kim, Kyu-Pyo, Park, Sook-Ryun, Ryu, Min-Hee, Ryoo, Baek-Yeol, Yoo, Changhoon
• Format: Journal Article
• Language: English
• Published: New Delhi Springer India 01.06.2024; Springer Nature B.V
• Subjects: Adult; Aged; Aged, 80 and over; Antibodies, Monoclonal, Humanized - administration & dosage; Antibodies, Monoclonal, Humanized - therapeutic use; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Bevacizumab; Bevacizumab - administration & dosage; Bevacizumab - therapeutic use; Carcinoma, Hepatocellular - drug therapy; Carcinoma, Hepatocellular - pathology; Colorectal Surgery; Etiology; Female; Hepatitis B; Hepatocellular carcinoma; Hepatology; Humans; Immune checkpoint inhibitors; Lesions; Liver cancer; Liver Neoplasms - drug therapy; Liver Neoplasms - pathology; Liver Neoplasms - virology; Lungs; Lymph nodes; Male; Medicine; Medicine & Public Health; Middle Aged; Original Article; PD-1 protein; Phenylurea Compounds - administration & dosage; Phenylurea Compounds - therapeutic use; Quinolines - administration & dosage; Quinolines - therapeutic use; Retrospective Studies; Subgroups; Surgery; Tumors; Hepatocellular carcinoma; Lenvatinib; Organ-specific response; Etiology of HCC; Atezolizumab-bevacizumab
• ISSN: 1936-0533; 1936-0541; 1936-0541
• DOI: 10.1007/s12072-023-10626-6

Background Immune checkpoint inhibitor (ICI)-based treatments have become the mainstay of first-line treatment for unresectable hepatocellular carcinoma (HCC), but there has been a concern that intrahepatic HCC lesions may be less responsive to ICI monotherapy. We aimed to investigate the organ-specific response patterns among unresectable HCC patients treated with first-line atezolizumab-bevacizumab or lenvatinib. Methods This retrospective study included 386 patients with Child–Pugh A unresectable HCC who were treated with first-line atezolizumab-bevacizumab ( n  = 217) or lenvatinib ( n  = 169). The organ-specific response was separately evaluated according to the site of the lesions: liver, lung, lymph node (LN), and intraabdomen based on a radiological evaluation adopted from RECIST v 1.1. Results The median age was 60 years. Hepatitis B infection was the most common etiology ( n  = 270, 69.9%), and 291 (75.4%) patients had a viral etiology. The proportion of patients achieving a ≥ 30% reduction in the tumor burden for each organ category was overall higher in the atezolizumab-bevacizumab group than that in the lenvatinib group: 20.2% vs. 11.8%, 23.0% vs. 12.2%, 27.9% vs. 17.9% and 33.3% vs. 15.0% for intrahepatic, lung, LN, and intraabdominal lesions, respectively. The corresponding values for the subgroup with a viral etiology were 17.3% vs. 8.1%, 18.8% vs. 13.3%, 28.9% vs. 3.6%, and 36.0% vs. 12.5%, respectively. Conclusion Compared to lenvatinib, atezolizumab-bevacizumab was associated with a favorable organ-specific response regardless of the site of the tumor lesions. Unlike anti-PD-1 monotherapy, atezolizumab-bevacizumab had a comparable organ-specific response between intrahepatic and extrahepatic lesions, especially for those with viral etiology HCCs.