Comparison of prognostic impact of atezolizumab plus bevacizumab versus lenvatinib in patients with intermediate‐stage hepatocellular carcinoma

Abstract Background & Aims The study goal was to compare the outcomes of patients with intermediate‐stage (Barcelona Clinic Liver Cancer [BCLC]‐B) hepatocellular carcinoma (HCC) who received atezolizumab plus bevacizumab (Atezo/Bev) or lenvatinib (LEN) as first‐line systemic therapy. Methods A total of 358 patients with BCLC‐B HCC treated with Atezo/Bev ( n = 177) or LEN ( n = 181) as first‐line systemic therapy were included. Results The median progression‐free survival (PFS) times in the Atezo/Bev and LEN groups were 10.8 months (95% confidence interval [CI], 7.8–12.6) and 7.3 months (95% CI, 6.3–8.5), respectively ( p = .019). In the propensity score‐matched cohort, the median PFS times in the Atezo/Bev ( n = 151) and LEN ( n = 151) groups were 10.2 months (95% CI, 7.0–12.3) and 6.9 months (95% CI, 5.9–8.1), respectively ( p = .020). Restricted mean survival times of PFS were significantly higher in the Atezo/Bev group than in the LEN group at landmarks of 12 and 18 months ( p = .031 and .012, respectively). In a subgroup analysis of patients with HCC beyond the up‐to‐seven criteria, the median PFS times in the Atezo/Bev ( n = 134) and LEN ( n = 117) groups were 10.5 months (95% CI, 7.0–11.8) and 6.3 months (95% CI, 5.5–7.3), respectively ( p = .044). Conclusions The use of Atezo/Bev as first‐line systemic therapy in patients with BCLC‐B HCC is expected to result in good PFS.