Treatment Outcomes of Tyrosine Kinase Inhibitors and Durvalumab Plus Tremelimumab After Atezolizumab Plus Bevacizumab for Hepatocellular Carcinoma

Background/Aim: Atezolizumab plus bevacizumab (AteBev) is widely used as a first-line treatment for advanced hepatocellular carcinoma (HCC). However, evidence regarding the optimal drug sequence following AteBev treatment is limited. This study aimed to compare the treatment outcomes between tyrosine kinase inhibitors (TKIs) and durvalumab plus tremelimumab (DurTre) following AteBev treatment. Patients and Methods: Overall, 134 consecutive patients who received AteBev for advanced HCC were enrolled in this study. Treatment outcomes were retrospectively compared between TKIs (AteBev-TKI group) and DurTre (AteBev-DurTre group). Results: The AteBev-TKI and Ate-DurTre groups included 46 and 7 patients, respectively. The AteBev-TKI group had significantly longer median progression-free survival after second-line treatment (3.6 vs. 0.94 months, p<0.001). The disease control rate was significantly higher in the AteBev-TKI group (p=0.020). The serum alpha-fetoprotein levels significantly decreased at one month in the AteBev-TKI group (0.909 vs. 1.435, p=0.035), whereas the albumin-bilirubin score significantly decreased at one month in the AteBev-TKI group (0.875 vs. 0.952, p=0.017). Each group reported no new unmanageable adverse events. Conclusion: TKIs may be a more optimal drug sequence than DurTre after AteBev treatment from an oncological perspective. TKIs following AteBev treatment require careful monitoring for deteriorating liver function.