First line atezolizumab/bevacizumab or durvalumab/tremelimumab in advanced hepatocellular carcinoma: a real world, multi-center retrospective study.

IF 4.2 2区医学 Q1 ONCOLOGY

Oncologist Pub Date : 2025-09-18 DOI:10.1093/oncolo/oyaf286

Ioannis Kournoutas, Paulina Marell, Jennifer Gile, Anina Peersen, Priyanshi Shah, Kyle VanDommelen, Suneel D Kamath, Garima Gupta, Mehmet Akce, Ju Dong Yang, Pin-Jung Chen, Nikolas Naleid, Amit Mahipal, Nicole Peterson, Vaibhav Sahai, Wen Wee Ma, Zhaohui Jin, Thorvardur Halfdanarson, Lionel Fonkoua Kankeu, Leslie A Washburn, Caitlin B Conboy, Michael Torbenson, Ajit Goenka, Scott Thompson, Sudhakar K Venkatesh, Patrick Starlinger, Lewis Roberts, Gregory J Gores, Hani Babiker, Daniel Ahn, Mitesh Borad, Tanios Bekaii-Saab, Aminah Jatoi, Robert R McWilliams, Fang-Shu Ou, Nguyen H Tran

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引用次数: 0

Abstract

Background: Unresectable hepatocellular carcinoma (uHCC) is a leading cause of cancer death. FDA-approved first-line systemic therapies include atezolizumab/bevacizumab (atezo/bev) and durvalumab/tremelimumab (durva/treme); however, there is a lack of comparative data.

Methods: We reviewed outcomes of patients with uHCC who initiated atezo/bev or durva/treme between 2017 and 2024, across six institutions. Overall survival (OS) and time to treatment discontinuation (TTD) were analyzed using the Kaplan-Meier and Cox models, adjusting for baseline characteristics.

Results: 452 uHCC pts were included. Median age: 68 years; 77% male; 81% white. Most common etiologies were viral hepatitis (38.9%) and metabolic dysfunction-associated steatohepatitis (19.5%). Disease progression was the primary reason for treatment discontinuation, atezo/bev (56%) and durva/treme (42%). Outcomes were not statistically significant (median OS [month, m]: 14.0 vs. 14.6 [p = 0.66]; median TTD [m]: 4.9 vs. 3.9 [p = 0.42] for atezo/bev vs. durva/treme). Outcomes were significantly different between Child-Pugh classes (CP: A, B7, B8/9, C) respectively, median OS(m): 19.0, 6.1, 5.1, 2.0 (p < 0.001); median TTD(m): 6.1, 2.3, 3.0, 1.3 (p < 0.001).

Conclusions: In this real-world study of uHCC, no significant difference in clinical outcomes was observed between atezo/bev and durva/treme in the first line setting. CP scores were a key prognostic variable with both regimens.

Implications for practice: This study offers real-world comparative data on two first line regimens in uHCC. As multiple first-line regimen combinations emerge, assessment of differences in efficacy, safety, and patient selection outside of clinical trials remain an unmet need. These findings may help guide treatment decisions, particularly in settings where toxicity, comorbidities, or resource constraints influence regimen choice.

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一线atezolizumab/bevacizumab或durvalumab/tremelimumab治疗晚期肝细胞癌：一项真实世界，多中心回顾性研究

背景：不可切除的肝细胞癌（uHCC）是癌症死亡的主要原因。fda批准的一线全身疗法包括atezolizumab/bevacizumab （atezo/bev）和durvalumab/tremelimumab (durva/treme)；然而，缺乏可比较的数据。方法：我们回顾了2017年至2024年间在6个机构接受atezo/bev或durva/treme治疗的uHCC患者的结局。使用Kaplan-Meier和Cox模型分析总生存期（OS）和治疗停药时间（TTD），并根据基线特征进行调整。结果：纳入452例uHCC患者。中位年龄：68岁；男性77%;81%是白人。最常见的病因是病毒性肝炎（38.9%）和代谢功能障碍相关的脂肪性肝炎（19.5%）。疾病进展是停药的主要原因，atezo/bev（56%）和durva/treme（42%）。结果无统计学意义（atezo/bev vs durva/treme的中位OS[月，m]: 14.0 vs. 14.6 [p = 0.66]；中位TTD [m]: 4.9 vs. 3.9 [p = 0.42]）。Child-Pugh分类（CP: A, B7, B8/9， C）之间的结果有显著差异，中位OS(m): 19.0, 6.1, 5.1, 2.0 (p)结论：在这项uHCC的真实世界研究中，在一线设置中，atezo/bev和durva/treme之间的临床结果无显著差异。CP评分是两种方案的关键预后变量。实践意义：本研究提供了两种一线治疗方案在uHCC中的真实对比数据。随着多种一线方案组合的出现，临床试验之外的疗效、安全性和患者选择的差异评估仍然是一个未满足的需求。这些发现可能有助于指导治疗决策，特别是在毒性、合并症或资源限制影响方案选择的情况下。

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

Oncologist 医学-肿瘤学

CiteScore

10.40

自引率

3.40%

发文量

309

审稿时长

3-8 weeks

期刊介绍： The Oncologist® is dedicated to translating the latest research developments into the best multidimensional care for cancer patients. Thus, The Oncologist is committed to helping physicians excel in this ever-expanding environment through the publication of timely reviews, original studies, and commentaries on important developments. We believe that the practice of oncology requires both an understanding of a range of disciplines encompassing basic science related to cancer, translational research, and clinical practice, but also the socioeconomic and psychosocial factors that determine access to care and quality of life and function following cancer treatment.