188P - Impact of metformin, statin, aspirin and insulin on the prognosis of unresectable HCC patients receiving first-line lenvatinib or atezolizumab plus bevacizumab

Background

Due to its complex pathophysiology, several comorbidities have to be taken in count in clinical decision-making process for hepatocellular carcinoma (HCC) patients. The aim of the present work was to investigate the potential prognostic role of metformin, aspirin, statins and insulin use in a cohort of advanced HCC patients who received Lenvatinib or atezolizumab plus bevacizumab as first- line treatment.

Methods

The population included HCC patients who received Atezolizumab plus Bevacizumab or Lenvatinib as first- line therapy. Univariate and multivariate analyses were performed by Cox proportional hazard to assess possible association between patients’ baseline characteristics and survival outcomes.

Results

730 patients with HCC were included in the analysis: 430 received Lenvatinib and 300 received Atezolizumab plus Bevacizumab. In both the treatment arms, no statistically differences in terms of OS and PFS were highlighted in patients who make chronic use of statin, aspirin or insulin compared to those who do not. In the Atezolizumab plus Bevacizumab arm, 50 (16.5%) patients were recorded to chronically use metformin. Patients in metformin group showed significantly shorter OS compared to patients in no-metformin group [respectively, 14.9 months (95% CI 6.4-16.3) vs. 19.7 (95% CI 16.0-30.4); HR 1.9 (95% CI 1.1-3.2) p = 0.0248], as confirmed in multivariate analysis (HR 1.9; 95% CI, 1.1-3.1; p=0.0163). Moreover, patients in metformin group had significantly shorter PFS compared to patients in no-metformin group [respectively, 4.5 months (95% CI 2.9-14.2) vs. 5.8 (95% CI 4.1-34.0); HR 1.6 (95% CI 1.0-2.6) p = 0.0212], as confirmed in multivariate analysis (HR 1.7; 95% CI, 1.1-2.7; p=0.0147).No statistically significant differences in terms of both OS and PFS were found between patients in metformin group and patients in no-metformin group in Lenvatinib arm.

Conclusions

The present study reports the first analysis focused on the role of metformin in a large double cohort of patients affected by advanced HCC who received Lenvatinib or Atezolizumab plus Bevacizumab, thus showing a negative prognostic role of metformin use in the Atezolizumab plus Bevacizumab group.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

the authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.