Efficacy and Safety of Lenvatinib Versus Atezolizumab plus Bevacizumab as First-Line Systemic Therapies for Hepatocellular Carcinoma : Experience from a Single UK Centre

Atezolizumab plus Bevacizumab (Atezo/Bev) and Lenvatinib (Len) are approved as first-line systemic therapies for unresectable or metastatic hepatocellular carcinoma (HCC) based on the results of benchmark studies which compared them with Sorafenib.1-2 However, there had been no head-to-head comparison between these two therapies in any randomized controlled clinical trials. Three systematic reviews and meta-analyses found no significant difference in the overall survival between patients treated with Atezo/Bev or Len.3-5 However, most had included studies from Asia, and all of them are retrospective cohort studies. Such results may not be generalisable to Western European populations, where the etiology and clinical presentation of HCC differ. In the United Kingdom, HCC is the 17th most common cancer, but the eighth most common cause of cancer-related death.6 More than 90% of patients with HCC have underlying liver diseases, such as alcoholic cirrhosis, metabolic dysfunction-associated steatotic liver disease (MASLD), or less commonly chronic viral hepatitis (CVH) infection from hepatitis B (HBV) and hepatitis C (HCV). Current 5-year survival of HCC in England is less than 20%, which can be variable in different cancer centres according to their social determinants. Colchester General Hospital (East Suffolk and North Essex Foundation Trust, ESNEFT) is part of the health care network of East England. All patients with a diagnosis of HCC were reviewed centrally at either the HCC Multidisciplinary Teams of Addenbrooke’s Hospital in Cambridge University or Royal Free Hospital in London, before they were referred back to receive systemic anti-cancer treatment locally. We report our experience of using Atezo/Bev and Len as first-line systemic therapies for HCC in the real world setting.