102P - A real-world study of the efficacy of second-line treatment of unresectable hepatocellular carcinoma after progression on first-line lenvatinib combined with PD-1 inhibitor

Background

Lenvatinib combined with immunotherapy is confirmed as an alternative first line treatment of unresectable hepatocellular carcinoma as a higher ORR. However, there is no evidence for second-line therapy after progression on lenvatinib combined with PD-1 inhibitor in unresectable hepatocellular carcinoma till now. Herein, we aim to investigate second-line treatment among this group of patients.

Methods

Thirty-three patients with unresectable hepatocellular carcinoma were admitted to the Second Affiliated Hospital of Nanchang University from January 2019 to December 2023. They were treated with first line lenvatinib in combination with PD-1 inhibitor. The efficacy was conducted according to the RECIST1.1 criteria. The endpoints included ORR, DCR, OS, and PFS.

Results

We identified a total of 225 patients with unresectable hepatocellular carcinoma who received first-line lenvatinib plus PD-1 inhibitor, of whom 33 received second-line therapy. 21 patients (63.6%)were treated with regorafenib plus PD-1 inhibitor, 6 patients(18.2%) with apatinib plus PD-1 inhibitor, 4 patients(12.1%) with bevacizumab plus PD-1 inhibitor, and the remaining 2 patients with regorafenib or sorafenib as monotherapy, respectively. Of the 33 patients, 2 (6.1%) were evaluated as PR, 16 (48.5%) had SD, and 15 (45.5%) experienced PD. The ORR was 6.1%, and the DCR was 54.6%. Median PFS was 4.5 months, median OS was 7.2 months, and the 12-month OS rate was 27.3%. As for different treatments in second line, The ORR of regorafenib plus PD-1 inhibitor was 9.5%, the DCR was 47.6%, the median PFS was 4.2 months, and the median OS was 5.9 months. None of the patients treated with apatinib plus PD-1 inhibitor got PR, the DCR was 83.3%, the median PFS was 8.7 months, and the median OS was 9.1 months. None of the patients treated with bevacizumab plus PD-1 inhibitor got PR, the DCR was 25%, the median PFS was 2.2 months, and the median OS was 6.0 months.

Conclusions

The second-line treatment of unresectable hepatocellular carcinoma after progression on first-line lenvatinib combined with PD-1 inhibitor is effective. Regorafenib or apatinib combined with PD-1 inhibitor might be the preferred regimen.

Legal entity responsible for the study

Fengming Yi.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.