Comparison outcome of transarterial chemoembolization combined with immune checkpoint inhibitors plus bevacizumab or lenvatinib as first-line therapy for advanced hepatocellular carcinoma.

Abstract

4141 Background: Transarterial chemoembolization (TACE) combined with immunotherapy and anti-angiogenic therapy for advanced hepatocellular carcinoma (HCC) presents a promising first-line treatment option. Methods: We assessed overall survival (OS), progression-free survival (PFS), objective response rate, and adverse events between the TACE-ICI-Len group (n=160) and the TACE-ICI-Bev group (n=216) as first-line therapy for advanced HCC. Inverse probability of treatment weighting was employed to minimize bias. Efficacy was evaluated using RECIST 1.1 and mRECIST criteria. Results: The TACE-ICI-Bev group demonstrated significantly improved OS and PFS compared to the TACE-ICI-Len group, especially across BCLC-B and BCLC-C stages (Total: mOS 22.8 vs. 15.4 months, p<0.001; mPFS 12.4 vs. 8.3 months, p<0.001; BCLC-B: mOS 23.3 vs. 16.6 months, p=0.005; mPFS 14.0 vs. 8.2 months, p<0.0001; BCLC-C: mOS 22.3 vs. 15.1 months, p=0.002; mPFS 11.0 vs. 8.0 months, p<0.001). Within the TACE-Bev-Ate subgroup, OS and PFS were further enhanced (Total: mOS 26.3 months; mPFS 13.8 months; BCLC-B: mOS 27.7 months; mPFS 16.7 months; BCLC-C: mOS 24.2 months; mPFS 12.6 months). The incidence of gastrointestinal bleeding (GB) was significantly higher in the TACE-ICI-Bev group compared to the TACE-ICI-Len group (13.8% vs. 6.2%, p<0.001). Notably, GB was significantly more frequent in patients with portal hypertension (PHT) compared to those without, in both the TACE-ICI-Bev group (30.9% vs. 6.6%, p<0.001) and the TACE-ICI-Len group (20.2% vs. 0%, p<0.001). Conclusions: TACE-ICI-Bev demonstrated superior OS and PFS compared to TACE-ICI-Len as first-line treatment for advanced HCC, with an acceptable safety. Management of PHT in patients with advanced HCC is critical to optimizing patient outcomes. Patient baseline characteristics before and after applying IPTW. Before IPTW After IPTW Variable TACE-ICI-Bev TACE-ICI-Len p TACE-ICI-Bev TACE-ICI-Len p n N=216 N=160 N=223.64 N=153.48 Age (mean (SD)) 59.21 (9.81) 57.19 (10.81) 0.059 57.59 (10.00) 57.23 (10.42) 0.780 Sex (%) 0.358 0.784 Female 37 (17.1) 21 (13.1) 33.1 (14.8) 24.6 (16.0) Male 179 (82.9) 139 (86.9) 190.6 (85.2) 128.9 (84.0) Hypertension (%) 0.46 0.928 No 152 (70.4) 106 (66.2) 150.8 (67.4) 104.3 (67.9) Yes 64 (29.6) 54 (33.8) 72.9 (32.6) 49.2 (32.1) DM (%) 0.176 0.981 No 147 (68.1) 120 (75.0) 164.3 (73.5) 112.5 (73.3) Yes 69 (31.9) 40 (25.0) 59.4 (26.5) 40.9 (26.7) ECOG_PS (%) <0.001 0.888 0 77 (35.6) 123 (76.9) 123.4 (55.2) 86.1 (56.1) 1 139 (64.4) 37 (23.1) 100.2 (44.8) 67.4 (43.9) TACE_number (%) 0.011 0.94 1~2 151 (69.9) 131 (81.9) 169.4 (75.7) 115.6 (75.3) >=3 65 (30.1) 29 (18.1) 54.3 (24.3) 37.9 (24.7) Child_Pugh_score (%) 0.125 0.629 <=6 117 (54.2) 73 (45.6) 109.7 (49.1) 70.6 (46.0) >6 99 (45.8) 87 (54.4) 113.9 (50.9) 82.9 (54.0) ALBI_grade (%) 0.367 0.536 I 94 (43.5) 78 (48.8) 102.7 (45.9) 64.6 (42.1) II-III 122 (56.5) 82 (51.2) 120.9 (54.1) 88.9 (57.9) BCLC_stage (%) 0.451 0.51 B 85 (39.4) 56 (35.0) 82.9 (37.1) 50.9 (33.1) C 131 (60.6) 104 (65.0) 140.7 (62.9) 102.6 (66.9) Lymphatic_metastasis (%) 0.001 0.845 No 126 (58.3) 65 (40.6) 107.1 (47.9) 75.4 (49.1) Yes 90 (41.7) 95 (59.4) 116.6 (52.1) 78.1 (50.9) Extrahepatic_metastasis (%) 0.11 0.536 No 179 (82.9) 121 (75.6) 172.1 (77.0) 123.2 (80.3) Yes 37 (17.1) 39 (24.4) 51.5 (23.0) 30.3 (19.7) Ascites (%) 0.298 0.35 No 146 (67.6) 99 (61.9) 150.5 (67.3) 94.8 (61.8) Yes 70 (32.4) 61 (38.1) 73.1 (32.7) 58.7 (38.2) Cirrhosis (%) 0.433 0.47 No 46 (21.3) 28 (17.5) 40.6 (18.2) 23.4 (15.2) Yes 170 (78.7) 132 (82.5) 183.0 (81.8) 130.1 (84.8) PHT (%) 0.425 0.698 No 106 (49.1) 71 (44.4) 111.6 (49.9) 72.8 (47.4) Yes 110 (50.9) 89 (55.6) 112.1 (50.1) 80.7 (52.6) Etiology_(%) 0.113 0.378 No/other 35(16.2) 16(10) 33.64 (12) 22.18 (14.6) HBV 181(83.8) 144(90) 190 (88) 131 (85.4) PVTT_classification_vp (%) 0.367 0.962 No 122 (56.5) 82 (51.2) 123.2 (55.1) 85.0 (55.4) VP1-VP4 94 (43.5) 78 (48.8) 100.5 (44.9) 68.5 (44.6) AFP_400 (%) 0.266 0.979 <400 119 (55.1) 78 (48.8) 112.8 (50.4) 77.1 (50.3) >=400 97 (44.9) 82 (51.2) 110.9 (49.6) 76.3 (49.7) Number_of_tumor (%) 0.979 0.678 <=3 62 (28.7) 47 (29.4) 66.0 (29.5) 41.7 (27.2) >3 154 (71.3) 113 (70.6) 157.6 (70.5) 111.7 (72.8) HCC_diameter_5 (%) 0.823 0.833 <5 60 (27.8) 47 (29.4) 65.8 (29.4) 47.1 (30.7) >=5 156 (72.2) 113 (70.6) 157.8 (70.6) 106.4 (69.3) NLR_grade (%) 0.902 0.884 <2.81 120 (55.6) 87 (54.4) 126.0 (56.4) 85.1 (55.5) >=2.81 96 (44.4) 73 (45.6) 97.6 (43.6) 68.4 (44.5) PLT (%) 0.082 0.901 <150 122 (56.5) 75 (46.9) 112.7 (50.4) 76.2 (49.6) >=150 94 (43.5) 85 (53.1) 110.9 (49.6) 77.3 (50.4)