Efficacy and Safety of Lenvatinib versus Atezolizumab Plus Bevacizumab in the Treatment of Unresectable Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis.

Q2 Medicine

Asian Pacific Journal of Cancer Prevention Pub Date : 2025-05-01 DOI:10.31557/APJCP.2025.26.5.1529

Ni Putu Sri Indrani Remitha, Ni Putu Rista Pradnya Dewi, I Komang Wira Ananta Kusuma, I Gede Aswin Parisya Sasmana, I Gede Putu Supadmanaba, Dwijo Anargha Sindhughosa, I Ketut Mariadi

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引用次数: 0

Abstract

Introduction: Hepatocellular carcinoma (HCC), the leading form of primary liver cancer, is strongly associated with liver cirrhosis and major risk factors such as hepatitis B and C, alcohol consumption, obesity, and non-alcoholic fatty liver disease. Despite treatment advancements, survival rates for unresectable HCC remain low. Lenvatinib and the combination of atezolizumab and bevacizumab (ATE/BEV) show promise, but further studies are needed to compare their clinical outcomes. This study aims to assess the efficacy and safety of LEN and ATE/BEV in unresectable HCC patients.

Methods: This research was conducted using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) strategy. Literature searches were conducted through PubMed, ScienceDirect, Google Scholar, Cochrane Library, SpringerLink, and Ebsco to gather studies on comparing LEN versus ATE/BEV for managing unresectable HCC. The quality assessment was assessed using the Newcastle-Ottawa Scale (NOS). Overall survival (OS), progression-free survival (PFS), objective response rate (ORR), disease control rate (DCR) and treatment-related adverse events (AEs) were evaluated using Review Manager 5.4 and RStudio 2024.04.1.

Results: Twelve retrospective studies were included, comprising 6,620 samples. There was no difference in the OS (HR=0.72; 95%CI: 0.44-1.18, p=0.20), PFS (HR=0.90; 95%CI: 0.75-1.07; p=0.23), ORR (OR=1.16; 95%CI:0.86-1.56; p=0.34) and DCR (OR=1.14; 95%CI:0.97-1.34; p=0.12) between groups. Moreover, in viral and non-viral patients group, LEN showed similar OS and PFS compared with ATE/BEV. In terms of safety, LEN exhibited higher incidences of decreased appetite (OR=2.95; 95%CI:1.12-7.79; p=0.03), diarrhea (OR=2.61; 95%CI:2.06-3.32; p<0.00001), fatigue (OR=1.48; 95%CI:1.27-1.73; P<0.00001), hand-foot syndrome (OR=7.73; 95%CI:4.84-12.33; P<0.00001), and showed lower incidences of increased aspartate aminotransferase (OR=0.44; 95%CI:0.28-0.69; p=0.0004) compared to ATE/BEV. Moreover, LEN showed similar AEs in grade ≥ 3 AEs (OR=1.15; 95%CI:0.29-4.55; p=0.84), hypertension (OR=1.39; 95%CI:0.84-2.28; p=0.20), proteinuria (OR=1.10; 95%CI:0.75-1.60; p=0.63) compared to ATE/BEV.

Conclusion: LEN was found to be non-inferior to ATE/BEV in terms of OS, PFS, ORR, DCR. However, LEN may be associated with a higher incidence of AEs.

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Lenvatinib与Atezolizumab + Bevacizumab治疗不可切除肝细胞癌的疗效和安全性：系统评价和荟萃分析。

肝细胞癌（HCC）是原发性肝癌的主要形式，与肝硬化以及乙肝和丙肝、饮酒、肥胖和非酒精性脂肪性肝病等主要危险因素密切相关。尽管治疗取得了进展，但不可切除的HCC的存活率仍然很低。Lenvatinib和atezolizumab / bevacizumab联合（ATE/BEV）显示出希望，但需要进一步的研究来比较它们的临床结果。本研究旨在评估LEN和ATE/BEV在不可切除的HCC患者中的疗效和安全性。方法：本研究采用PRISMA（系统评价和荟萃分析首选报告项目）策略进行。通过PubMed、ScienceDirect、谷歌Scholar、Cochrane Library、SpringerLink和Ebsco进行文献检索，收集LEN与ATE/BEV治疗不可切除HCC的比较研究。质量评估采用纽卡斯尔-渥太华量表（NOS）。使用Review Manager 5.4和RStudio 2024.04.1评估总生存期（OS）、无进展生存期（PFS）、客观缓解率（ORR）、疾病控制率（DCR）和治疗相关不良事件（ae）。结果：纳入12项回顾性研究，共6620份样本。两组间OS无差异(HR=0.72；95%CI: 0.44-1.18, p=0.20), PFS (HR=0.90；95%置信区间:0.75—-1.07;p=0.23), ORR (OR=1.16；95%置信区间:0.86—-1.56;p=0.34)和DCR (OR=1.14；95%置信区间:0.97—-1.34;P =0.12)。此外，在病毒和非病毒患者组中，LEN的OS和PFS与ATE/BEV相比相似。在安全性方面，LEN表现出较高的食欲下降发生率(OR=2.95；95%置信区间:1.12—-7.79;p=0.03)，腹泻(OR=2.61；95%置信区间:2.06—-3.32;结论：LEN在OS、PFS、ORR、DCR方面均优于ATE/BEV。然而，LEN可能与较高的ae发生率相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Asian Pacific Journal of Cancer Prevention 医学-肿瘤学

CiteScore

2.80

自引率

0.00%

发文量

779

审稿时长

3 months

期刊介绍： Cancer is a very complex disease. While many aspects of carcinoge-nesis and oncogenesis are known, cancer control and prevention at the community level is however still in its infancy. Much more work needs to be done and many more steps need to be taken before effective strategies are developed. The multidisciplinary approaches and efforts to understand and control cancer in an effective and efficient manner, require highly trained scientists in all branches of the cancer sciences, from cellular and molecular aspects to patient care and palliation. The Asia Pacific Organization for Cancer Prevention (APOCP) and its official publication, the Asia Pacific Journal of Cancer Prevention (APJCP), have served the community of cancer scientists very well and intends to continue to serve in this capacity to the best of its abilities. One of the objectives of the APOCP is to provide all relevant and current scientific information on the whole spectrum of cancer sciences. They aim to do this by providing a forum for communication and propagation of original and innovative research findings that have relevance to understanding the etiology, progression, treatment, and survival of patients, through their journal. The APJCP with its distinguished, diverse, and Asia-wide team of editors, reviewers, and readers, ensure the highest standards of research communication within the cancer sciences community across Asia as well as globally. The APJCP publishes original research results under the following categories: -Epidemiology, detection and screening. -Cellular research and bio-markers. -Identification of bio-targets and agents with novel mechanisms of action. -Optimal clinical use of existing anti-cancer agents, including combination therapies. -Radiation and surgery. -Palliative care. -Patient adherence, quality of life, satisfaction. -Health economic evaluations.