972P - Sequential therapies after atezolizumab plus bevacizumab or lenvatinib first-line treatments in advanced hepatocellular carcinoma

Background

Today the most used first-line treatments in hepatocellular carcinoma (HCC) patients are lenvatinib (L) and atezolizumab plus bevacizumab (AB). All the data available about second-line therapies derive from trials conducted in patients who progressed to first-line sorafenib therapy. The aim of this retrospective proof-of-concept study is to compare different second-line drugs for HCC patients progressed to first-line L or AB.

Methods

The overall cohort included 2225 consecutive patients from 5 countries (Italy, Germany, Portugal, Japan, and Republic of Korea). A total of 1381 patients had progressed disease (PD) at first-line therapy. 917 patients were in L first-line arm, and 464 patients were in AB first-line arm.

Results

49.6% of PD patients received a second-line therapy without any statistical difference in OS between L (20.6 months) and AB first-line [15.7 months; p = 0.12; hazard ratio (HR) = 0.80]. After L first-line, there wasn’t any statistical difference between second-line therapy subgroups (p = 0.27; sorafenib HR: 1; immunotherapy HR: 0.69; other therapies HR: 0.85). Patients who underwent TACE had a significative longer OS than patients who received sorafenib (24.7 vs. 15.8 months, p < 0.01; HR = 0.64). After AB first-line, there was a statistical difference between second-line therapy subgroups (p < 0.01; sorafenib HR: 1; L HR: 0.50; cabozantinib HR: 1.29; other therapies HR: 0.54). Patients who received L (17.0 months) and those who underwent TACE (15.9 months) had a significative longer OS than patients treated with sorafenib (14.2 months; respectively, p = 0.01; HR = 0.45, and p < 0.05; HR = 0.46).

Conclusions

Approximately half of patients receiving first-line L or AB access second-line treatment. Our data suggest that in patients progressed to AB, the systemic therapy able to achieve the longest survival is L, while in patients progressed to L, the systemic therapy able to achieve the longest survival is immunotherapy.

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.