Survival outcomes from atezolizumab plus bevacizumab versus Lenvatinib in Child Pugh B unresectable hepatocellular carcinoma patients
Survival outcomes from atezolizumab plus bevacizumab versus Lenvatinib in Child Pugh B unresectable hepatocellular carcinoma patients
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阿特朱单抗联合贝伐单抗与乐伐替尼治疗 Child Pugh B 型不可切除肝细胞癌患者的生存结果
DOI：
10.1007/s00432-023-04678-2
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发表时间：
2023
影响因子：
3.6
通讯作者：
Sho T
中科院分区：
文献类型：
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作者：
Rimini M;Persano M;Tada T;Suda G;Shimose S;Kudo M;Cheon J;Finkelmeier F;Lim HY;Presa J;Salani F;Lonardi S;Piscaglia F;Kumada T;Sakamoto N;Iwamoto H;Aoki T;Chon HJ;Himmelsbach V;Schirripa M;Montes M;Vivaldi C;Solda C;Hiraoka A;Sho T
对于Child-Pugh（CP）分级为B的晚期肝细胞癌（HCC）患者，最佳的一线治疗方法仍不清楚。本研究的目的是进行一个真实世界的分析与CP B与atezolizumab加贝伐单抗VS Lenvatinib治疗的大样本的HCC患者包括受晚期（BCLC-C）或中期（BCLC-B）HCC患者不适合局部治疗从西方和东方世界（意大利、德国、韩国和日本），接受atezolizumab+贝伐珠单抗或乐伐替尼作为一线治疗。所有研究人群的CP分类均为B。本研究的主要终点是接受乐伐替尼治疗的CP B患者与接受atezolizumab+贝伐珠单抗治疗的CP B患者相比的总生存期（OS）。使用Kaplan-Meier乘积限法估计存活曲线。分层因素的作用进行了分析与对数秩检验。结果217例CP B HCC患者入组研究，65例（30%）接受atezolizumab联合贝伐单抗治疗，152例（70%）接受乐伐替尼治疗。接受乐伐替尼治疗的患者的mOS为13.8个月（95% CI：11.6-16.0），而接受atezolizumab+贝伐珠单抗作为一线治疗的患者为8.2个月（95% CI 6.3-10.2）（atezolizumab+贝伐珠单抗Vs乐伐替尼：HR 1.9，95% CI 1.2- 3.0，p = 0.0050）。在mPFS方面未突出显示统计学显著性差异。多变量分析证实，接受乐伐替尼一线治疗的患者的OS显著长于接受atezolizumab+贝伐珠单抗的患者（HR 2.01; 95% CI 1.29- 3.25，p = 0.0023）。通过评估接受atezolizumab联合贝伐单抗治疗的患者队列，我们发现ECOG PS 0的Child B患者，或BCLC B期或ALBI 1级是那些从治疗中获益的患者，因此与接受Lenvatinib的患者相比，生存结局无显著差异。CP B级HCC患者。
IntroductionThe best first-line treatment for patients with advanced hepatocellular carcinoma (HCC) and Child–Pugh (CP) class B remains unknown. The aim of the present study was to perform a real-world analysis on a large sample of patients with unresectable HCC with CP B treated with atezolizumab plus bevacizumab Vs Lenvatinib.MethodsThe study population included patients affected by advanced (BCLC-C) or intermediate (BCLC-B) HCC patients not suitable for locoregional therapies from both the Western and Eastern world (Italy, Germany, Republic of Korea and Japan), who received atezolizumab plus bevacizumab or Lenvatinib as first-line treatment. All the study population presented a CP class of B. The primary endpoint of the study was the overall survival (OS) of CP B patients treated with Lenvatinib compared to atezolizumab plus bevacizumab. Survival curves were estimated using the product-limit method of Kaplan–Meier. The role of stratification factors was analyzed with log-rank tests. Finally, an interaction test was performed for the main baseline clinical characteristics.Results217 CP B HCC patients were enrolled in the study: 65 (30%) received atezolizumab plus bevacizumab, and 152 (70%) received lenvatinib. The mOS for patients receiving Lenvatinib was 13.8 months (95% CI: 11.6–16.0), compared to 8.2 months (95% CI 6.3–10.2) for patients receiving atezolizumab plus bevacizumab as first-line treatment (atezolizumab plus bevacizumab Vs Lenvatinib: HR 1.9, 95% CI 1.2–3.0,p= 0.0050). No statistically significant differences were highlighted in terms of mPFS. The multivariate analysis confirmed that patients receiving Lenvatinib as first-line treatment have a significantly longer OS compared to patients receiving atezolizumab plus bevacizumab (HR 2.01; 95% CI 1.29–3.25,p= 0.0023). By evaluating the cohort of patients who received atezolizumab plus bevacizumab, we found that Child B patients with ECOG PS 0, or BCLC B stage or ALBI grade 1 were those who had benefited from the treatment thus showing survival outcomes no significantly different compared to those receiving Lenvatinib.ConclusionThe present study suggests for the first time a major benefit from Lenvatinib compared to atezolizumab plus bevacizumab in a large cohort of patients with CP B class HCC.
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DOI：
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影响因子：
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