Atezolizumab Plus Bevacizumab Provides Efficacy Similar to Lenvatinib in Elderly Patients With HCC

Elderly patients with previously untreated hepatocellular carcinoma (HCC) may benefit equally from a combination of atezolizumab and bevacizumab compared with lenvatinib.

As older patients may have a reduced immune capacity, researchers from Japan aimed to compare the efficacy of atezolizumab plus bevacizumab with lenvatinib for patients with HCC who were 80 years of age or older. Lenvatinib was approved as a first-line treatment for unresectable HCC in 2018 and has demonstrated superior efficacy in patients when compared with sorafenib.

Researchers retrospectively analyzed patients from March 2018 to July 2022, with 170 patients receiving lenvatinib and 92 patients receiving atezolizumab plus bevacizumab. In both groups, the median age was 83 years (P=.3) and men accounted for approximately 70% of patients.

The objective response rate was 35.9% in the lenvatinib group and 33.7% in the atezolizumab-plus-bevacizumab group (P=.8). Disease control rates were 62.9% in patients receiving lenvatinib and 63.0% in those receiving atezolizumab plus bevacizumab (P=1.0).

The median progression-free survival (PFS) and overall survival (OS) rates were not significantly different between the groups (6.3 months and 17.9 months in the lenvatinib group and 7.2 months and 14.0 months in the atezolizumab-plus-bevacizumab group, respectively). Upon multivariate analysis, the choice of treatment had no association with PFS or OS.

A significantly higher rate of postprogression treatment was seen in the atezolizumab-plus-bevacizumab group compared with the lenvatinib group (59.0% vs 35.7%; P=.01), as well as a lower rate of discontinuation due to adverse events (AEs; 69 [40.6%] vs 19 [20.7%]; P<.001). The most common AEs in both treatment groups included appetite loss, fatigue, and proteinuria. AEs more common in the lenvatinib group included diarrhea, hand-foot skin reaction, and hypothyroidism.

While the rate of grade 3 hypertension was significantly higher in patients receiving atezolizumab plus bevacizumab, there was a lower rate of discontinuation due to AEs.

Atezolizumab plus bevacizumab provides similar efficacy as lenvatinib in patients with HCC aged 80 years or older. The combination can serve as a potential first-line treatment in this patient population.