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Journal of Cancer Research and Clinical Oncology

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02-09-2023 | Lenvatinib | Review

Efficacy and safety of atezolizumab plus bevacizumab versus lenvatinib for unresectable hepatocellular carcinoma: a systematic review and meta-analysis

Authors: Junning Liu, Linfeng Yang, Song Wei, Jijiang Li, Pengsheng Yi

Published in: Journal of Cancer Research and Clinical Oncology | Issue 17/2023

Abstract

Background

Atezolizumab plus bevacizumab and lenvatinib are the current first-line systematic therapy for unresectable hepatocellular carcinoma (uHCC). However, the selection of initial treatment among the two therapies are controversial. This meta-analysis aims to compare efficacy and safety between atezolizumab plus bevacizumab and lenvatinib.

Methods

We systematically searched for studies on atezolizumab plus bevacizumab and lenvatinib in the online databases PubMed, Embase, Web of Science and Cochrane Library. The outcome data including overall survival (OS), progression free survival (PFS), tumor response and adverse events (AEs), were independently extracted by two authors in a standardized way.

Results

Eight retrospective cohort studies with 3690 patients (atezolizumab plus bevacizumab: 1680, lenvatinib: 2010) were included in the meta-analysis. The atezolizumab plus bevacizumab group had significant longer PFS [hazard ratio (HR) 0.76, 95% confidence intervals (CI) 0.65–0.88; I squared statistic (I²) = 0.0%, p = 0.590], compared with lenvatinib group but no significant difference in OS (HR 0.87, 95% CI 0.75–1.01; I² = 0.0%, p = 0.597), objective response rate (ORR) [risk ratio (RR) 0.89, 95% CI 0.79–1.02; I² = 19.3%, p = 0.283] and disease control rate (DCR) (RR 1.03, 95% CI 0.98–1.09; I² = 0.0%, p = 0.467) among them. Moreover, patients receiving atezolizumab plus bevacizumab exhibited lower incidences of grade 3/4 AEs than those receiving lenvatinib (RR 0.65, 95% CI 0.51–0.83; I² = 69.3%, p = 0.003). However, in non-viral patients group, lenvatinib delivered favorable outcomes in OS (HR 1.32, 95% CI 1.04–1.67; I² = 0.0%, p = 0.380) compared with atezolizumab plus bevacizumab.

Conclusion

Atezolizumab plus bevacizumab provides potential advantage in efficacy and better safety than lenvatinib in the treatment of uHCC. Lenvatinib is an appropriate effective alternative to atezolizumab plus bevacizumab in patients without viral infecting.

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Title: Efficacy and safety of atezolizumab plus bevacizumab versus lenvatinib for unresectable hepatocellular carcinoma: a systematic review and meta-analysis
Authors: Junning Liu
Linfeng Yang
Song Wei
Jijiang Li
Pengsheng Yi
Publication date: 02-09-2023
Publisher: Springer Berlin Heidelberg
Keywords: Lenvatinib
Bevacizumab
Hepatocellular Carcinoma
Hepatocellular Carcinoma
Sorafenib
Published in: Journal of Cancer Research and Clinical Oncology / Issue 17/2023
Print ISSN: 0171-5216
Electronic ISSN: 1432-1335
DOI: https://doi.org/10.1007/s00432-023-05342-5

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