Lenvatinib Demonstrates Significant Benefit vs Atezolizumab Plus Bevacizumab for Hepatocellular Carcinoma

Andrea Casadei-Gardini, MD, San Raffaele Hospital, Milan, Italy, discusses findings from an international study examining atezolizumab plus bevacizumab vs lenvatinib or sorafenib in patients with non-viral unresectable hepatocellular carcinoma (HCC). The study showed a significant survival benefit with lenvatinib compared to atezolizumab plus bevacizumab in this patient population.

These findings were presented at the 2022 ESMO World Congress on Gastrointestinal Cancer in Barcelona, Spain.

Transcript:

I am Andrea Casadei-Gardini, and I am an oncologist. I work at the San Raffaele Hospital in Milan. Today I presented my data here at the ESMO World Congress. The background of my work is that we see different responses to treatment in patients with immunotherapy vs tyrosine kinase inhibitors (TKI) based on the etiology of liver disease.

Several studies have shown that immunotherapy is less effective in patients with a non-viral etiology compared to patients with liver etiology. Last year, my colleagues and I published our paper that highlighted patients with epithelial cellular carcinoma treated with lenvatinib and found improved outcomes in patients with NASH/NAFLD versus patients with non-NASH/NAFLD. From this result, we decide to perform a multicentric, retrospective study across four countries and 56 hospitals, in which we compared the efficacy of atezolizumab plus bevacizumab versus lenvatinib and/or sorafenib in patients with a non-viral etiology. Our findings are especially important to the treatment decisions in the clinical setting.

Our data highlighted that lenvatinib has more efficacy in patients with non-viral etiology when compared with atezolizumab plus bevacizumab, especially in overall survival in patients with NASH/NAFLD etiology. Our data found very impressive results in terms of median overall survival. For patients treated with lenvatinib, the median overall survival was 21 months versus 12 months in patients treated with atezolizumab plus bevacizumab.

In non-NASH/NAFLD patients without viral etiology, we highlighted no difference in outcomes between atezolizumab plus bevacizumab versus lenvatinib. To reduce the bias of our study, we decided to perform a propensity score match analysis, after which the 2 populations were completely in balance. From there we confirmed the results of improved overall survival in patients treated with lenvatinib compared with atezolizumab plus bevacizumab.

Finally, we saw no difference in non-viral patients in the NASH/NAFLD population versus the non-NASH/NAFLD population, whether patients were treated with atezolizumab plus bevacizumab or sorafenib.

We concluded that etiology is important in choosing the best treatment for our patients. While this real-world data is not a phase 3 trial, I think it still opens a new window to choose the best treatment option for our patients. Though it is not yet possible to decide the best treatment based on the etiology for our patients, it is important to do a new study phase 3 trials based on etiology, the clinical outcome, the clinical impact of non-viral NASH/NAFLD versus viral etiology in our patients. Thank you very much.

Source:

Rimini M, Rimassa L, Kudo M, et al. Atezolizumab plus bevacizumab versus lenvatinib or sorafenib in non-viral unresectable hepatocellular carcinoma: An international study. Presented at: ESMO World Congress on Gastrointestinal Cancer; June 29-July 2, 2022. Barcelona, Spain. Abstract SO-14.