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Original Article Comparison of atezolizumab plus bevacizumab and lenvatinib for hepatocellular carcinoma with portal vein tumor thrombosis
Jeayeon Park1orcid , Yun Bin Lee1orcid , Yunmi Ko1orcid , Youngsu Park1orcid , Hyunjae Shin1orcid , Moon Haeng Hur1orcid , Min Kyung Park1orcid , Dae-Won Lee2orcid , Eun Ju Cho1orcid , Kyung-Hun Lee2orcid , Jeong-Hoon Lee1orcid , Su Jong Yu1orcid , Tae-Yong Kim2orcid , Yoon Jun Kim1orcid , Tae-You Kim2orcid , Jung-Hwan Yoon1orcid

DOI: https://doi.org/10.17998/jlc.2023.12.25 [Accepted]
Published online: January 19, 2024
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1Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
2Cancer Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
Corresponding author:  Yun Bin Lee,
Email: yblee@snu.ac.kr
Received: 28 September 2023   • Revised: 13 December 2023   • Accepted: 25 December 2023

Background/Aim
Atezolizumab plus bevacizumab and lenvatinib are currently available as first-line therapy for the treatment of unresectable hepatocellular carcinoma (HCC); however, comparative efficacy studies are still limited. This study aimed to investigate the effectiveness of these treatments in HCC patients with portal vein tumor thrombosis (PVTT).
Methods
We retrospectively included patients who received either atezolizumab plus bevacizumab or lenvatinib as first-line systemic therapy for HCC with PVTT. Primary endpoint was overall survival (OS), and secondary endpoints included progression-free survival (PFS) and disease control rate (DCR) determined by Response Evaluation Criteria in Solid Tumors, version 1.1.
Results
A total of 52 patients were included: 30 received atezolizumab plus bevacizumab and 22 received lenvatinib. The median follow-up duration was 6.4 months (interquartile range, 3.9–9.8). The median OS was 10.8 months (95% confidence interval [CI], 5.7–not estimated) with atezolizumab plus bevacizumab and 5.8 months (95% CI, 4.8–not estimated) with lenvatinib (P=0.26 by log-rank test). There was no statistically significant difference in OS (adjusted hazard ratio [aHR], 0.71; 95% CI, 0.34–1.49; P=0.37). The median PFS was similar (P=0.63 by log-rank test), with 4.1 months (95% CI, 3.3–7.7) for atezolizumab plus bevacizumab and 4.3 months (95% CI, 2.6–5.8) for lenvatinib (aHR, 0.93; 95% CI, 0.51–1.69; P=0.80). HRs were similar after inverse probability treatment weighting. The DCRs were 23.3% and 18.2% in patients receiving atezolizumab plus bevacizumab and lenvatinib, respectively (P=0.74).
Conclusion
The effectiveness of atezolizumab plus bevacizumab and lenvatinib was comparable for the treatment of HCC with PVTT.


JLC : Journal of Liver Cancer