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Abstract Details |
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Clinical outcomes with atezolizumab plus bevacizumab or lenvatinib in patients with hepatocellular carcinoma: a multicenter real-world study |
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J Cancer Res Clin Oncol. 2023 Aug;149(9):5591-5602.doi: 10.1007/s00432-022-04512-1. Epub 2022 Dec 13.
Mara Persano # 1, Margherita Rimini # 2, Toshifumi Tada 3, Goki Suda 4, Shigeo Shimose 5, Masatoshi Kudo 6, Jaekyung Cheon 7, Fabian Finkelmeier 8, Ho Yeong Lim 9, Lorenza Rimassa 10 11, José Presa 12, Gianluca Masi 13 14, Changhoon Yoo 15, Sara Lonardi 16, Francesco Tovoli 17, Takashi Kumada 18, Naoya Sakamoto 4, Hideki Iwamoto 5, Tomoko Aoki 6, Hong Jae Chon 7, Vera Himmelsbach 8, Tiziana Pressiani 11, Takumi Kawaguchi 5, Margarida Montes 12, Caterina Vivaldi 13 14, Caterina Soldà 16, Fabio Piscaglia 17, Atsushi Hiraoka 19, Takuya Sho 4, Takashi Niizeki 5, Naoshi Nishida 6, Christoph Steup 8, Massimo Iavarone 20, Giovanni Di Costanzo 21, Fabio Marra 22, Mario Scartozzi 1, Emiliano Tamburini 23, Giuseppe Cabibbo 24, Francesco Giuseppe Foschi 25, Marianna Silletta 26, Masashi Hirooka 27, Kazuya Kariyama 28, Joji Tani 29, Masanori Atsukawa 30, Koichi Takaguchi 31, Ei Itobayashi 32, Shinya Fukunishi 33, Kunihiko Tsuji 34, Toru Ishikawa 35, Kazuto Tajiri 36, Hironori Ochi 37, Satoshi Yasuda 38, Hidenori Toyoda 38, Chikara Ogawa 39, Takashi Nishimura 40, Takeshi Hatanaka 41, Satoru Kakizaki 42, Noritomo Shimada 43, Kazuhito Kawata 44, Fujimasa Tada 19, Hideko Ohama
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Author information
- 1Medical Oncology, University Hospital of Cagliari, Cagliari, Italy.
- 2Department of Medical Oncology, IRCCS San Raffaele Hospital, Via Olgettina n. 60, Milan, Italy. margherita.rimini@gmail.com.
- 3Department of Internal Medicine, Japanese Red Cross Himeji Hospital, Himeji, Japan.
- 4Department of Gastroenterology and Hepatology, Graduate School of Medicine, Hokkaido University, North 15, West 7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan.
- 5Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka, 830-0011, Japan.
- 6Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Higashi-Osaka, Japan.
- 7Department of Medical Oncology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea.
- 8Department of Internal Medicine 1, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany.
- 9Department of Medicine, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, South Korea.
- 10Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
- 11Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
- 12Liver Unit-CHTMAD, Vila Real, Portugal.
- 13Unit of Medical Oncology 2, University Hospital of Pisa, Pisa, Italy.
- 14Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.
- 15Department of Oncology, ASAN Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-gil, Songpa-gu, Seoul, 05505, Korea.
- 16Oncology Unit 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy.
- 17Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italy.
- 18Department of Nursing, Gifu Kyoritsu University, Ogaki, Japan.
- 19Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan.
- 20Division of Gastroenterology and Hepatology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy.
- 21Department of Hepatology, 80131, Naples, Italy.
- 22Dipartimento di Medicina Sperimentale e Clinica, Università di Firenze, Firenze, Italy.
- 23Department of Oncology and Palliative Care, Cardinale G Panico, Tricase City Hospital, Tricase, Italy.
- 24Section of Gastroenterology and Hepatology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, 90127, Palermo, Italy.
- 25Department of Internal Medicine, Ospedale per gli Infermi di Faenza, Faenza, Italy.
- 26Division of Medical Oncology, Policlinico Universitario Campus Bio-Medico, Rome, Italy.
- 27Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Ehime, Japan.
- 28Department of Gastroenterology, Okayama City Hospital, Okayama, Japan.
- 29Department of Gastroenterology and Hepatology, Kagawa University, Kagawa, Japan.
- 30Division of Gastroenterology and Hepatology, Department of Internal Medicine, Nippon Medical School, Tokyo, Japan.
- 31Department of Hepatology, Kagawa Prefectural Central Hospital, Takamatsu, Japan.
- 32Department of Gastroenterology, Asahi General Hospital, Asahi, Japan.
- 33Department of Gastroenterology, Osaka Medical and Pharmaceutical University, Osaka, Japan.
- 34Center of Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan.
- 35Department of Gastroenterology, Saiseikai Niigata Hospital, Niigata, Japan.
- 36Department of Gastroenterology, Toyama University Hospital, Toyama, Japan.
- 37Hepato-biliary Center, Japanese Red Cross Matsuyama Hospital, Matsuyama, Japan.
- 38Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Japan.
- 39Department of Gastroenterology, Japanese Red Cross Takamatsu Hospital, Takamatsu, Japan.
- 40Division of Gastroenterology and Hepatology, Department of Internal medicine, Hyogo Medical University, Nishinomiya, Japan.
- 41Department of Gastroenterology, Gunma Saiseikai Maebashi Hospital, Maebashi, Japan.
- 42Department of Clinical Research, National Hospital Organization Takasaki General Medical Center, Takasaki, Japan.
- 43Division of Gastroenterology and Hepatology, Otakanomori Hospital, Kashiwa, Japan.
- 44Department of Hepatology, Hamamatsu University School of Medicine, Hamamatsu, Japan.
- 45Department of Surgery, Kansai Medical University, Osaka, Japan.
- 46Department of Gastroenterology, National Hospital Organization Takasaki General Medical Center, Takasaki, Japan.
- 47Drug Development Unit, Sarah Cannon Research Institute UK, London, UK.
- 48Department of Medical Oncology, IRCCS San Raffaele Hospital, Via Olgettina n. 60, Milan, Italy.
- 49Department of Oncology, IRCCS San Raffaele Scientific Institute Hospital, Vita-Salute San Raffaele University, Milan, Italy.
#Contributed equally.
Abstract
Purpose: The purpose of this study is to compare response rates of lenvatinib and atezolizumab plus bevacizumab, in first-line real-world setting.
Methods: Overall cohort included Western and Eastern hepatocellular carcinoma (HCC) patient populations from 46 centres in 4 countries (Italy, Germany, Japan, and Republic of Korea).
Results: 1312 patients were treated with lenvatinib, and 823 patients were treated with atezolizumab plus bevacizumab. Objective response rate (ORR) was 38.6% for patients receiving lenvatinib, and 27.3% for patients receiving atezolizumab plus bevacizumab (p < 0.01; odds ratio 0.60). For patients who achieved complete response (CR), overall survival (OS) was not reached in both arms, but the result from univariate Cox regression model showed 62% reduction of death risk for patients treated with atezolizumab plus bevacizumab (p = 0.05). In all multivariate analyses, treatment arm was not found to be an independent factor conditioning OS. Comparing ORR achieved in the two arms, there was a statistically significant difference in favor of lenvatinib compared to atezolizumab plus bevacizumab in all subgroups except for Eastern patients, Child-Pugh B patients, presence of portal vein thrombosis, α-feto-protein ≥ 400 ng/mL, presence of extrahepatic disease, albumin-bilirubin (ALBI) grade 2, and no previous locoregional procedures.
Conclusion: Lenvatinib achieves higher ORR in all patient subgroups. Patients who achieve CR with atezolizumab plus bevacizumab can achieve OS so far never recorded in HCC patients. This study did not highlight any factors that could identify patient subgroups capable of obtaining CR.
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