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Lenvatinib Versus Atezolizumab Plus Bevacizumab in the First-Line Treatment for Unresectable Hepatocellular Carcinoma: A Meta-Analysis of Real-World Studies

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Abstract

Background

Immunotherapy has revolutionized the treatment of hepatocellular carcinoma (HCC). However, whether adding immunotherapy to antiangiogenic therapy benefits patients with unresectable HCC (uHCC) more in the first-line setting remains controversial.

Objective

In this analysis, we compared the clinical outcomes of lenvatinib monotherapy with atezolizumab plus bevacizumab combination therapy in advanced uHCC in real-world clinical practice.

Methods

The MEDLINE, Embase, and Cochrane CENTRAL databases were systematically searched on 23 April 2023. The “metaSurvival” and “meta” packages of the R software (version 4.2.2) were used to summarize the survival curves and meta-analyze the survival data. Overall survival (OS) and progression-free survival (PFS) were defined as dual primary endpoints. Secondary endpoints included the objective response rate (ORR) and disease control rate (DCR).

Results

Overall, the pooled median OS was 18.4 months in the lenvatinib group versus 18.5 months in the atezolizumab plus bevacizumab group; the pooled median PFS was 6.9 months in the lenvatinib group versus 7.3 months in the atezolizumab plus bevacizumab group. Lenvatinib therapy showed similar OS [hazard ratio (HR): 0.91, 95% confidence interval (CI): 0.55–1.52, p = 0.72] and PFS (HR: 0.79, 95% CI: 0.56–1.12, p = 0.19) compared with atezolizumab plus bevacizumab therapy. In addition, a comparable ORR [odds ratio (OR): 0.89, 95% CI: 0.65–1.20, p = 0.44) was observed between lenvatinib and atezolizumab plus bevacizumab.

Conclusions

Comprehensive analysis suggested that lenvatinib monotherapy exhibited survival outcomes comparable to those of atezolizumab plus bevacizumab combination therapy, which may provide useful insights for clinicians in future clinical practice.

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Acknowledgements

We thank Wang’s group for providing statistical support and for editing the manuscript.

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Authors and Affiliations

  1. Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China

    Bi-Cheng Wang & Bo-Hua Kuang

  2. Department of Oncology, The Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, China

    Guo-He Lin

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Correspondence to Bi-Cheng Wang.

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Funding

No external funding was used in the preparation of this manuscript.

Conflict of Interest

Bi-Cheng Wang, Bo-Hua Kuang, and Guo-He Lin declare that they have no conflicts of interest that might be relevant to the contents of this manuscript.

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Not applicable.

Availability of Data and Materials

All included real-world studies were searched for and downloaded from official websites. 1. https://link.springer.com/article/https://doi.org/10.1007/s00432-023-04678-2; 2. https://link.springer.com/article/https://doi.org/10.1007/s00432-022-04512-1; 3. https://onlinelibrary.wiley.com/doi/https://doi.org/10.1002/cam4.5506; 4. https://linkinghub.elsevier.com/retrieve/pii/S0959-8049(22)01762-2; 5. https://link.springer.com/article/https://doi.org/10.1007/s11523-022-00921-x; 6. https://linkinghub.elsevier.com/retrieve/pii/S2059-7029(22)00221-6; 7. https://onlinelibrary.wiley.com/doi/https://doi.org/10.1002/cam4.4854; 8. https://onlinelibrary.wiley.com/doi/https://doi.org/10.1111/hepr.13771; 9. https://www.mdpi.com/2072-6694/14/7/1747.

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Author Contributions

Study design: Bi-Cheng Wang; data extraction: Bi-Cheng Wang and Guo-He Lin; data analysis: Bi-Cheng Wang and Bo-Hua Kuang; Manuscript writing and editing: all authors.

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Wang, BC., Kuang, BH. & Lin, GH. Lenvatinib Versus Atezolizumab Plus Bevacizumab in the First-Line Treatment for Unresectable Hepatocellular Carcinoma: A Meta-Analysis of Real-World Studies. Targ Oncol 19, 203–212 (2024). https://doi.org/10.1007/s11523-024-01035-2

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