Background: The combination of anti-angiogenic therapy and immune checkpoint inhibitors has revolutionized the management of unresectable hepatocellular carcinoma (uHCC). While an early-phase study demonstrated promising outcomes for lenvatinib plus pembrolizumab (L+P) in treating uHCC, the LEAP-002 trial did not meet its primary endpoint. However, the comparative efficacy between L+P and atezolizumab plus bevacizumab (A+B) as first-line treatment remains a topic of uncertainty. This study aimed to assess the effectiveness and safety of L+P in contrast to A+B among patients diagnosed with uHCC. Methods: We conducted a retrospective analysis of enrolled patients with uHCC who received L+P or A+B as initial systemic treatment at Chang Gung Memorial Hospital from June 2019 to December 2022. The overall survival (OS), progression-free survival (PFS), objective response rate (ORR), and disease control rate (DCR) by modified RECIST were compared. Results: 121 patients were recruited, with 37 receiving L+P and 84 receiving A+B. Among them, 95 (78.5%) patients were BCLC stage C, and 99 (81.8%) patients had viral etiology for HCC, predominantly chronic HBV (68.6%). Both the L+P and the A+B groups demonstrated comparable OS (18.2 months versus 14.6 months,p= 0.35) and PFS (7.3 months versus 8.9 months,p= 0.75). The ORR and DCR were similar. After propensity score matching, the results remained consistent between the matched patients. Treatment-related adverse events of any grade occurred in 30 (81.1%) in the L+P group and 62 (73.8%) in the A+B group. Conclusions: Our findings suggest that L+P and A+B exhibit comparable efficacy and safety profiles in real-world settings.
背景：抗血管生成治疗与免疫检查点抑制剂的联合应用已彻底改变了不可切除肝细胞癌（uHCC）的治疗格局。尽管早期研究显示仑伐替尼联合帕博利珠单抗（L+P）治疗uHCC具有良好前景，但LEAP-002试验未能达到其主要终点。然而，L+P与阿替利珠单抗联合贝伐珠单抗（A+B）作为一线治疗的疗效比较仍存在不确定性。本研究旨在评估L+P与A+B在uHCC患者中的疗效与安全性差异。 方法：本研究回顾性分析了2019年6月至2022年12月期间在长庚纪念医院接受L+P或A+B作为初始系统治疗的uHCC患者。通过改良RECIST标准比较两组的总生存期（OS）、无进展生存期（PFS）、客观缓解率（ORR）和疾病控制率（DCR）。 结果：共纳入121例患者，其中37例接受L+P治疗，84例接受A+B治疗。95例（78.5%）患者为BCLC C期，99例（81.8%）患者具有病毒性肝癌病因，主要为慢性HBV感染（68.6%）。L+P组与A+B组在OS（18.2个月 vs 14.6个月，p=0.35）和PFS（7.3个月 vs 8.9个月，p=0.75）方面表现相当。两组ORR与DCR结果相似。经过倾向评分匹配后，匹配患者间的结果保持一致性。治疗相关不良事件发生率在L+P组为81.1%（30例），A+B组为73.8%（62例）。 结论：本研究结果表明，在真实世界临床实践中，L+P与A+B方案在uHCC治疗中展现出相当的疗效与安全性特征。
肿瘤(癌症)患者之家