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Efficacy of Atezolizumab Plus Bevacizumab Versus Lenvatinib in Patients with Unresectable Hepatocellular Carcinoma: a Meta-analysis

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Abstract

Introduction

Hepatocellular carcinoma is a lethal disease and there has been a debate regarding the first-line treatment of its advanced and unresectable form. Observational studies have explored atezolizumab plus bevacizumab versus lenvatinib, yielding mixed results. This systematic review and meta-analysis aim to compare efficacy and safety of both treatment arms.

Methods

A systematic literature review was conducted in accordance with PRISMA guidelines. Randomized control trials, cohort studies, or case–control that included patients above age 60 with unresectable hepatocellular carcinoma confirmed by radiological imaging were included. At least one of the outcomes: overall survival (OS), progression-free survival (PFS), objective response rate (ORR), duration of response, or adverse events was included in the selected studies.

Results

Ten cohorts were included in the analysis with a total of 6493 patients. Nine of the included studies had patients with advanced HCC (BCLC-C) or intermediate HCC (BCLC-B) and 1 study included patients with all three stages (BCLC-A, BCLC-B, and BCLC-C). Of these patients, 2524 patients received atezolizumab plus bevacizumab (A + B) combination while 3969 received lenvatinib. The overall survival was better statistically in the A + B group then the lenvatinib group (MD: − 5.06; 95% CI: − 7.79 to − 2.33; p = 0.0003, I2 = 0%). The progression-free survival was significantly improved in A + B arm as well group (MD: − 4.96; 95% CI: − 7.67 to − 2.26; I2 = 0%, p = 0. 0003). There was no significant difference in objective response rate, disease control rate, and frequency of adverse events in either of the group.

Conclusion

Our study concluded that combination therapy with atezolizumab plus bevacizumab could increase the survival duration without affecting the disease course. Moreover, while the severity of adverse events was greater in the A + B group, their frequency was comparable to the lenvatinib group.

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Data Availability

The datasets associated with this study can be obtained upon reasonable request from the corresponding author.

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Authors and Affiliations

  1. Quetta Institute of Medical Sciences, Quetta, Pakistan

    Mah I Kan Changez

  2. Dow University of Health Sciences, Karachi, Pakistan

    Maimoona Khan, Muhammad Uzair, Vania Saqib, Muhammad Khizer Molani & Saad Khalid

  3. H.B.S Medical and Dental College, Islamabad, Pakistan

    Muhammad Fawad Tahir

  4. Jinnah Sindh Medical University, Karachi, Pakistan

    Maryam Mohsin

  5. Ziauddin Medical College, Karachi, Pakistan

    Amna Faiyaz Hussain

  6. Islamic International Medical College, Islamabad, Pakistan

    Aisha Habib Ahmed

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Contributions

Changez MIK made substantial contributions to the conception or design of the study and drafted the manuscript. Khan M, Tahir MF, Mohsin M drafted the manuscript. Changez MIK, Khan M and Ahmed AH contributed in analyses of the data. Hussain AF, Saqib V, and Molani MK participated in literature search and data extraction. Uzair M revised the article critically for intellectual content. Khalid S supervised the project, made contributions to the conception and design of the study and critically revised the manuscript. All authors read and approved the final manuscript.

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Correspondence to Maimoona Khan.

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Changez, M., Khan, M., Uzair, M. et al. Efficacy of Atezolizumab Plus Bevacizumab Versus Lenvatinib in Patients with Unresectable Hepatocellular Carcinoma: a Meta-analysis. J Gastrointest Canc 55, 467–481 (2024). https://doi.org/10.1007/s12029-023-00999-0

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