Bevacizumab-atezolizumab (B-A), durvalumab-tremelimumab (D-T) and lenvatinib (L) in advanced hepatocellular carcinoma patient therapy: An efficacy comparison study based on real-world evidence.

516 Background: B+A, D+T and L are recognized as standard first-line therapy in aHCC patients, but there are no direct comparative studies among them. We conduct a retrospective comparative analysis utilizing RWE, adhering to the ESMO Guidance for Reporting Oncology Real-World Evidence (ESMO-GROW) criteria. Methods: The investigators employed the TriNetX Global Collaborative Network, a platform that aggregates worldwide retrospective anonymized clinical data. A cohort of aHCC patients from 150 participating healthcare organizations (HCOs) who fulfilled the specified eligibility criteria was identified. Overall survival (OS) was evaluated in B+A, D+T and L patient cohorts, utilizing Kaplan-Meier analysis in a one-to-one comparison. Hazard Ratio (HR) and 95% confidence intervals (95%CI) were calculated to assess differences in survival outcomes. Propensity Score Matching (PSM) was implemented to control for potential confounding variables, including age, gender and race/ethnicity. All statistical analyses were conducted using the TriNetX Analytics function within the online research platform. Results: A total of 3306 HCC patients from 66 HCOs were identified, 1173 on A+B cohort, , 309 on D+T cohort and 1824 on L cohort. Patients treated with A+B demonstrate a median OS of 16,6 months in contrast to 13,01 for those receiving L. The median follow-up duration was 13.91 months for B+A and 14.10 for L cohort in this comparison. The OS was significantly superior in A+B cohort comparing with L cohort following PSM (post-PMS HR 0.873, 95%CI 0.75-0.935, p=0.0016). A+B vs. D+T and D+T vs. L did not show significant differences in OS. Conclusions: This RWE study demonstrates a OS benefit comparing bevacizumab plus atezolizumab over Lenvatinib. B+A versus D+T and D+T versus L comparisons did not show OS differences.