Efficacy of Lenvatinib versus Bevacizumab in Triple Therapy with Immune Checkpoint Inhibitors and Interventional Therapy for Hepatocellular Carcinoma with Macrovascular Invasion: A Multi-Center Real-World Retrospective Study

Background

Hepatocellular carcinoma (HCC) patients with macrovascular invasion (MaVI) continue to experience a dismal prognosis and the optimal drug combination choices remain undefined. The aim of this study was to compare the clinical efficacy and safety of lenvatinib-based triple therapy versus bevacizumab-based triple therapy, as first-line treatment for patients with MaVI. Patients and methods: This retrospective multicenter study enrolled 184 consecutive patients from three centers in China, all of whom received first-line lenvatinib (n=126) or bevacizumab (n=58) combined with immune checkpoint inhibitors (ICIs) and interventional therapy (TACE and/or HAIC). The primary endpoints were progression-free survival (PFS) and overall survival (OS). Propensity score matching (PSM) was applied to balance baseline clinical characteristics, and inverse probability of treatment weighting (IPTW) was subsequently applied to assess the robustness of the findings.