Real-World Effectiveness of Atezolizumab-Bevacizumab, Lenvatinib and Sorafenib in the Patients With Unresectable Hepatocellular Carcinoma: A Multi-institutional Study in Taiwan
Author(s)
KAI-CHENG CHANG, MS1, Hui-Yu Chen, MS2, Chia-Hsun Hsieh, PhD2, Huang-tz Ou, PhD3.
1PhD student, National Cheng Kung University, Taoyuan City, Taiwan, 2Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, 3School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine,, National Cheng Kung University, Tainan, Taiwan.
1PhD student, National Cheng Kung University, Taoyuan City, Taiwan, 2Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, 3School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine,, National Cheng Kung University, Tainan, Taiwan.
OBJECTIVES: In recent years, there are several breakthrough systemic treatments, including atezolizumab plus bevacizumab (atezo/beva) and lenvatinib, as first-line therapies for locally advanced hepatocellular carcinoma (HCC). However, real-world comparative data involving all three treatment groups, particularly in Asian populations, remain limited.
METHODS: We conducted a retrospective cohort study from electronic medical records from a multi-institutional healthcare System in Taiwan. Patients diagnosed with BCLC stage B or C HCC who initiated first-line systemic therapy with atezo/beva, lenvatinib, or sorafenib between 2017 and 2022 were included. Patients were followed until death, loss to follow-up, or December 31, 2024, whichever occurred first. The primary outcomes were overall survival (OS) and progression-free survival (PFS). Propensity score matching with multiple treatments group were applied to balance baseline characteristics. Sensitivity and subgroup analyses, including variations in inclusion period, alternative propensity score methods, and imputation of missing data, were applied to assess the robustness of the findings.
RESULTS: We included a total of 3,833 patients meeting all study criteria. Among these patients, 295 (7.7%) received atezo/beva, 1042 (27.2%) received lenvatinib, and 2496 (65.1%) received sorafenib as first-line treatment for HCC. Before matching, atezo/beva group had youngest age and worst disease burden (e.g., presence of macrovascular invasion, extra-hepatic spread, highest alpha fetoprotein level and worst liver functions). After matching, baseline characteristics were well-balanced across the groups. The median OS was 11.0, 10.3 and 7.3 months among atezo/beva, lenvatinib and sorafenib groups, respectively (log rank test, P < 0.05). Besides, the median PFS was 6.3, 6.5 and 4.4 months among atezo/beva, lenvatinib and sorafenib groups, respectively (log rank test, P < 0.05). Sensitivity analyses showed similar results compared to main analyses.
CONCLUSIONS: Both atezo/beva and lenvatinib were associated with improved clinical outcomes compared to sorafenib in a real-world cohort of Taiwanese HCC patients. Further studies are warranted to identify treatment-specific prognostic factors.
METHODS: We conducted a retrospective cohort study from electronic medical records from a multi-institutional healthcare System in Taiwan. Patients diagnosed with BCLC stage B or C HCC who initiated first-line systemic therapy with atezo/beva, lenvatinib, or sorafenib between 2017 and 2022 were included. Patients were followed until death, loss to follow-up, or December 31, 2024, whichever occurred first. The primary outcomes were overall survival (OS) and progression-free survival (PFS). Propensity score matching with multiple treatments group were applied to balance baseline characteristics. Sensitivity and subgroup analyses, including variations in inclusion period, alternative propensity score methods, and imputation of missing data, were applied to assess the robustness of the findings.
RESULTS: We included a total of 3,833 patients meeting all study criteria. Among these patients, 295 (7.7%) received atezo/beva, 1042 (27.2%) received lenvatinib, and 2496 (65.1%) received sorafenib as first-line treatment for HCC. Before matching, atezo/beva group had youngest age and worst disease burden (e.g., presence of macrovascular invasion, extra-hepatic spread, highest alpha fetoprotein level and worst liver functions). After matching, baseline characteristics were well-balanced across the groups. The median OS was 11.0, 10.3 and 7.3 months among atezo/beva, lenvatinib and sorafenib groups, respectively (log rank test, P < 0.05). Besides, the median PFS was 6.3, 6.5 and 4.4 months among atezo/beva, lenvatinib and sorafenib groups, respectively (log rank test, P < 0.05). Sensitivity analyses showed similar results compared to main analyses.
CONCLUSIONS: Both atezo/beva and lenvatinib were associated with improved clinical outcomes compared to sorafenib in a real-world cohort of Taiwanese HCC patients. Further studies are warranted to identify treatment-specific prognostic factors.
Conference/Value in Health Info
2025-09, ISPOR Real-World Evidence Summit 2025, Tokyo, Japan
Value in Health Regional, Volume 49S (September 2025)
Code
RWD93
Topic Subcategory
Health & Insurance Records Systems
Disease
SDC: Oncology