Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
Se Jun Park
Division of Medical Oncology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, Cancer Research Institute, The Catholic University of Korea, Seoul, Republic of Korea
Jin Won Kim
Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
David Wai Meng Tai
Division of Medical Oncology, National Cancer Center Singapore, Singapore, Singapore
Division of Hematology-Oncology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
Krittiya Korphaisarn
Division of Medical Oncology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Suebpong Tanasanvimon
King Chulalongkorn Memorial Hospital, Bangkok, Thailand
San-Chi Chen
Division of Medical Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
Ju Won Kim
Division of Oncology/Hematology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
Ilhwan Kim
Division of Oncology, Department of Internal Medicine, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
Moonho Kim
Department of Hematology and Oncology, University of Ulsan College of Medicine, Gangneung Asan Hospital, Gangneung, Republic of Korea
Joan Choo
Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore
Sang-Bo Oh
Division of Hematology-Oncology, Department of Internal Medicine, School of Medicine, Yangsan Pusan National University Hospital, Busan, Republic of Korea
Ching-Tso Chen
National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
Woo Kyun Bae
Division of Hematology-Oncology, Department of Internal Medicine, Chonnam National University Medical School and Hwasun Hospital, Gwangju, Republic of Korea
Hongsik Kim
Division of Hematology-Oncology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
Seok Jae Huh
Dong-A University Hospital, Busan, Republic of Korea
Chia-Jui Yen
Department of Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
Sejung Park
Sondang Institute for Cancer Research, Yonsei University College of Medicine, Seoul, Republic of Korea
Dong Ki Lee
Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
Landon Long Chan
Department of Clinical Oncology, Sir YK Pao Centre for Cancer, Hong Kong Cancer Institute, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong, China
Beodeul Kang
Division of Medical Oncology, Department of Internal Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
Minsu Kang
Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
Raghav Sundar
Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore
Hye Jin Choi
Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
Department of Clinical Oncology, Sir YK Pao Centre for Cancer, Hong Kong Cancer Institute, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong, China
Hong Jae Chon
Division of Medical Oncology, Department of Internal Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
Myung-Ah Lee
Division of Medical Oncology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, Cancer Research Institute, The Catholic University of Korea, Seoul, Republic of Korea
Introduction: Atezolizumab plus bevacizumab is a commonly used first-line regimen for advanced hepatocellular carcinoma (HCC) treatment owing to its superior outcomes compared to sorafenib. However, optimal subsequent treatment options for patients with HCC who progressed on first-line atezolizumab plus bevacizumab remain unclear. Methods: This multinational, multi-institutional, retrospective study included patients with HCC from 22 centers in five Asia-Pacific countries who were treated with first-line atezolizumab plus bevacizumab, which was discontinued for any reason. The endpoints included progression-free survival (PFS) and overall survival (OS) according to patient characteristics and second-line regimens. Results: Between June 2016 and May 2023, 1,141 patients were treated with first-line atezolizumab plus bevacizumab, of whom 629 (55.1%) received subsequent treatment. Sorafenib and lenvatinib were the most commonly administered second-line regimens (53.9% and 25.6%, respectively). Overall, the median PFS and OS were 2.9 and 8.0 months, respectively. Lenvatinib had longer PFS (4.0 vs. 2.3 months) and OS (8.0 vs. 6.3 months) than sorafenib. Patients treated with tyrosine kinase inhibitor (TKI) plus immune checkpoint inhibitor (ICI) (n = 50, 8.3%) showed PFS and OS of 5.4 and 12.6 months, respectively. Lower tumor burden and lenvatinib or TKI plus ICI use were associated with longer second-line PFS. Preserved liver function was associated with improved OS. Conclusions: In patients with HCC who progressed on first-line atezolizumab plus bevacizumab, sorafenib and lenvatinib were the most commonly used second-line regimens in Asia-Pacific countries, with lenvatinib resulting in longer OS than sorafenib. The second-line TKI plus ICI combination exhibited promising efficacy, suggesting the potential role of continuing ICIs beyond disease progression.
