Background: Although atezolizumab plus bevacizumab (hereinafter, atezolizumab–bevacizumab) is the standard first-line treatment for patients with advanced HCC, the optimal second-line regimen remains unknown. This study evaluated the efficacy and safety of sorafenib and lenvatinib in patients with advanced HCC that progressed under atezolizumab–bevacizumab treatment. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched PubMed, Embase, and the Cochrane Library for articles published before November 2023. Random-effects meta-analysis was performed to determine the pooled objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), and overall survival (OS), comparing patients who received sorafenib versus lenvatinib. Results: Seven studies involving 387 patients were included. The pooled ORR, DCR, OS, and PFS for sorafenib and lenvatinib together were 26% (95% CI: 14–43%), 63% (95% CI: 47–77%), 11.45 months (95% CI: 7.12–15.77,I2= 92%,p< 0.01), and 3.78 months (95% CI: 2.34–5.23,I2= 67%,p= 0.02), respectively. Although lenvatinib users had a longer median OS (12.42 vs. 10.75 months) and PFS (5.15 vs. 2.58 months) than sorafenib users, the pooled ORR, DCR, median OS, and PFS for these medications were comparable. Additionally, the distributions of all-grade and grade ≥ 3 adverse events for sorafenib and lenvatinib were comparable to those for these two medications when used as first-line therapies. Conclusions: Sorafenib or lenvatinib can provide effective treatment with manageable toxicity in patients with advanced HCC after disease progression under atezolizumab–bevacizumab.
背景：尽管阿替利珠单抗联合贝伐珠单抗（以下简称阿替利珠-贝伐珠方案）是晚期肝细胞癌（HCC）患者的一线标准治疗方案，但最佳的二线治疗方案仍不明确。本研究评估了索拉非尼和仑伐替尼在阿替利珠-贝伐珠方案治疗后进展的晚期HCC患者中的疗效与安全性。 方法：遵循系统综述与荟萃分析优先报告条目（PRISMA）指南，我们检索了截至2023年11月发表在PubMed、Embase和Cochrane图书馆的相关文献。采用随机效应模型进行荟萃分析，汇总比较接受索拉非尼与仑伐替尼治疗患者的客观缓解率（ORR）、疾病控制率（DCR）、无进展生存期（PFS）和总生存期（OS）。 结果：共纳入7项研究，涉及387例患者。索拉非尼与仑伐替尼的汇总ORR、DCR、OS和PFS分别为26%（95% CI：14–43%）、63%（95% CI：47–77%）、11.45个月（95% CI：7.12–15.77，I²= 92%，p< 0.01）和3.78个月（95% CI：2.34–5.23，I²= 67%，p= 0.02）。虽然仑伐替尼使用者的中位OS（12.42个月 vs. 10.75个月）和PFS（5.15个月 vs. 2.58个月）较索拉非尼使用者更长，但两种药物的汇总ORR、DCR、中位OS和PFS具有可比性。此外，索拉非尼和仑伐替尼的所有级别不良事件及≥3级不良事件的发生情况，与这两种药物作为一线治疗时的分布相当。 结论：对于阿替利珠-贝伐珠方案治疗后疾病进展的晚期HCC患者，索拉非尼或仑伐替尼能提供有效治疗且毒性可控。
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