Atezolizumaba plus bevacizumab is Associated with Favorable Overall Survival Over Lenvatinib in Patients with Unresectable Hepatocellular Carcinoma

Introduction: This study aimed to compare the effectiveness outcomes of Child-Pugh class A patients with unresectable hepatocellular carcinoma (HCC) treated with first-line atezolizumab-bevacizumab and lenvatinib. Methods: This retrospective study included patients with Child-Pugh A unresectable HCC who were administered first-line treatment with either atezolizumab-bevacizumab (n = 368) or lenvatinib (n = 229) at Asan Medical Center (Seoul, Korea). Effectiveness outcomes were analyzed along with the inverse probability treatment weighting (IPTW) analysis to adjust for potential confounders. Results: Hepatitis B virus infection was the most common cause of HCC. With median follow-up duration of 11.9 for atezolizumab-bevacizumab and 20.9 months for the lenvatinib groups, patients treated with atezolizumab-bevacizumab exhibited superior progression-free survival (PFS) and overall survival (OS) than those treated with lenvatinib (median PFS 6.3 vs. 4.9 months, P = 0.031; and median OS 18.5 vs. 11.3 months, P < 0.001). After IPTW adjustment, atezolizumab-bevacizumab remained associated with favorable OS (median OS of 17.9 vs. 12.3 months, P = 0.010). Treatment with atezolizumab-bevacizumab was an independent factor of OS in both the entire and IPTW-adjusted cohorts. For patients with a viral etiology, the atezolizumab-bevacizumab group exhibited significantly longer OS than the lenvatinib group in both entire and IPTW-adjusted cohorts (P < 0.001 and P = 0.006, respectively). Conversely, both groups showed comparable OS among those with a nonviral etiology (P = 0.656 and P = 0.616, respectively). Conclusions: Atezolizumab-bevacizumab showed superior OS compared to lenvatinib in Asian patients with unresectable HCC.