Liver Cancer (Aug 2024)

Real-World Study of Systemic Treatment after First-Line Atezolizumab plus Bevacizumab for Hepatocellular Carcinoma in Asia-Pacific Countries

  • Choong-kun Lee,
  • Changhoon Yoo,
  • Jung Yong Hong,
  • Se Jun Park,
  • Jin Won Kim,
  • David Wai Meng Tai,
  • Hyeyeong Kim,
  • Krittiya Korphaisarn,
  • Suebpong Tanasanvimon,
  • San-Chi Chen,
  • Ju Won Kim,
  • Ilhwan Kim,
  • Moonho Kim,
  • Joan Choo,
  • Sang-Bo Oh,
  • Ching-Tso Chen,
  • Woo Kyun Bae,
  • Hongsik Kim,
  • Seok Jae Huh,
  • Chia-Jui Yen,
  • Sejung Park,
  • Dong Ki Lee,
  • Landon Long Chan,
  • Beodeul Kang,
  • Minsu Kang,
  • Raghav Sundar,
  • Hye Jin Choi,
  • Stephen Lam Chan,
  • Hong Jae Chon,
  • Myung-Ah Lee

DOI
https://doi.org/10.1159/000540969

Abstract

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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.

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