Comparative analysis of the therapeutic outcomes of atezolizumab plus bevacizumab and lenvatinib for hepatocellular carcinoma patients aged 80years and older: Multicenter study.

Abstract

Elderly patients are believed to have a reduced immune capacity, which may make immunotherapy less effective. The aim of this study was to compare the therapeutic outcome of atezolizumab plus bevacizumab (Atez/Bev) and lenvatinib (LEN) for advanced hepatocellular carcinoma (HCC) in patients aged 80years and older. From March 2018 to July 2022, 170 and 92 elderly patients who received LEN and Atez/Bev as first-line treatment, respectively, were retrospectively analyzed. The median ages of the Atez/Bev and LEN groups were 83.0 (8.01-86.0) and 83.0 (82.0-86.0) years (p=0.3), respectively. Men accounted for approximately 70% of the patients in both groups. The objective response rate was 35.9% in the LEN group and 33.7% in the Atez/Bev group (p=0.8), whereas the disease control rates in the LEN and Atez/Bev groups were 62.9% and 63.0%, respectively (p=1.0). The median progression-free survival (PFS) in the LEN and Atez/Bev groups was 6.3 and 7.2months, respectively, which were not significantly different (p=0.2). The median overall survival (OS) was 17.9months in the LEN group and 14.0months in the Atez/Bev group. This difference was not statistically significant (p=0.7). In multivariate analyses, the choice of treatment (LEN vs. Atez/Bev) showed no association with PFS or OS. The Atez/Bev group had a significantly higher rate of postprogression treatment (59.0% vs. 35.7%, p=0.01) and a lower rate of discontinuation due to adverse events (69 [40.6%] vs. 19 [20.7%], p<0.001) compared to the LEN group. Atezolizumab plus bevacizumab showed comparable effectiveness to LEN in HCC patients aged 80years and older. Given the results of postprogression treatment and discontinuation due to adverse events, Atez/Bev could serve as a first-line treatment even for elderly HCC patients.