Comparison Analysis of Lenvatinib Plus Transcatheter Arterial Chemoembolization Versus Atezolizumab Plus Bevacizumab as First‐Line Therapy for Intermediate‐Stage Hepatocellular Carcinoma Beyond the Up‐to‐Seven Criteria

ABSTRACT Background and Aim This study aimed to compare the therapeutic effects and safety of lenvatinib (LEN) plus transcatheter arterial chemoembolization (LEN‐TACE) and atezolizumab plus bevacizumab (Atez/Bev) as the first‐line therapies in patients with intermediate‐stage hepatocellular carcinoma (HCC) beyond the up‐to‐seven criteria. Methods We enrolled 768 patients with HCC treated with first‐line systemic therapy, and 154 patients were enrolled and categorized into either the LEN‐TACE therapy ( n = 42) or Atez/Bev ( n = 112) groups. After propensity score matching (PSM), 72 patients (LEN‐TACE group, n = 36; Atez/Bev group, n = 36) were analyzed. Results After PSM, the median progression‐free survival showed no significant differences between the LEN‐TACE and Atez/Bev groups (8.5 [95% confidence interval (CI): 6.1–10.7] months vs. 8.6 (95% CI: 5.3–12.1) months, respectively; p = 0.973). Regarding median overall survival (OS), no significant differences were noted between the LEN‐TACE and Atez/Bev groups (37.3 [95% CI: 31.2–60.2] months vs. 32.4 (95% CI: 19.5–NE) months, respectively; p = 0.183). Regarding adverse events (AEs) of grade ≥ 3, no significant difference was observed between the two groups. Multivariate analysis revealed that the ALBI grade 1 and low AFP levels were independent factors for OS. Conclusion LEN‐TACE therapy may be one of the effective treatment strategies in intermediate‐stage HCC patients beyond the up‐to‐seven criteria.