eISSN: 2449-8238
ISSN: 2392-1099
Clinical and Experimental Hepatology
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3/2023
vol. 9
 
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abstract:
Original paper

Atezolizumab plus bevacizumab versus lenvatinib as first-line therapy for advanced hepatocellular carcinoma: A systematic review and meta-analysis

Suprabhat Giri
1
,
Sumaswi Angadi
1
,
Arun Vaidya
2
,
Ankita Singh
2
,
Akash Roy
3
,
Sridhar Sundaram
4

  1. Nizam’s Institute of Medical Sciences, India
  2. Seth GS Medical College and KEM Hospital, India
  3. Apollo Multispecialty Hospital, India
  4. Tata Memorial Hospital, India
Clin Exp HEPATOL 2023; 9, 3: 228-235
DOI: https://doi.org/10.5114/ceh.2023.130748
Online publish date: 2023/09/03
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Aim of the study:
Studies comparing atezolizumab plus bevacizumab (ATE/BEV) vs. lenvatinib (LEN) for advanced hepatocellular carcinoma (aHCC) have shown conflicting results. With this background, we aimed to collate the available evidence comparing ATE/BEV and LEN in aHCC.

Material and methods:
A comprehensive search of three databases was conducted from inception to November 2022 for studies comparing ATE/BEV with LEN for managing aHCC. Results were presented with their 95% confidence intervals (95% CI) as the hazard ratio (HR) for time-to-event outcomes or odds ratios (OR) for dichotomous outcomes.

Results:
A total of 8 studies were included. On analysis of matched cohorts, there was no difference in the objective response rate (ORR) (adjusted odds ratio [aOR] = 1.15, 95% CI: 0.83-1.61) or disease control rate (DCR) (aOR = 0.83, 95% CI: 0.49-1.38) between groups. Three studies reported a significantly longer progression-free survival (PFS) with ATE/LEN, while one reported a longer PFS with LEN. The adjusted hazard ratio (aHR) for PFS available from three studies was comparable (HR = 1.06, 95% CI: 0.75-1.50). Data were insufficient to carry out a formal analysis for overall survival (OS), but none of the studies reported any difference in OS. On comparison of overall adverse events (AE) and ≥ grade 3 AE, there was no difference in the overall analysis, but higher risk of AE with LEN on sensitivity analysis.

Conclusions:
Based on the currently available literature, LEN was found to be non-inferior to ATE/BEV in terms of ORR, DCR, and PFS. However, LEN may be associated with a higher incidence of AEs. Further head-to-head trials are required to demonstrate the superiority of ATE/BEV over LEN.

keywords:

meta-analysis, hepatocellular carcinoma, atezolizumab, lenvatinib, immune checkpoint inhibitors
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