HAIC combined with atezolizumab and bevacizumab versus lenvatinib in advanced hepatocellular carcinoma: a multicenter propensity score matching analysis.

PURPOSE: This study aimed to evaluate the clinical efficacy and safety of hepatic arterial infusion chemotherapy (HAIC) combined with atezolizumab and bevacizumab (HTA) versus HAIC combined with lenvatinib (HL) in the treatment of advanced hepatocellular carcinoma (HCC). METHODS: A multicenter retrospective study was conducted between June 2021 and June 2025, reviewing advanced HCC patients treated with either HTA or HL. To mitigate initial differences between the two groups, propensity score matching (PSM) was applied. Tumor response was assessed using the RECIST version 1.1 criteria. The primary endpoint was overall survival (OS). Secondary efficacy outcomes included progression-free survival (PFS), objective response rate (ORR), and disease control rate (DCR). Safety was assessed by the incidence and severity of adverse events (AEs). RESULTS: A total of 187 patients received HTA, and 119 patients received HL. Following PSM, 106 patients were assigned to each group. The HTA group demonstrated a significantly longer median OS (25.8 months vs. 16.4 months; hazard ratio [HR], 0.62, P = 0.012) compared to the HL group. However, no significant difference in median PFS was observed (9.7 months vs. 7.6 months; HR, 0.88, P = 0.407). Additionally, the two groups showed comparable ORR (56.6% vs. 53.8%, P = 0.78) and DCR (86.8% vs. 84.9%, P = 0.84). There were no significant differences in the incidence of all AEs or grade 3/4 AEs between the two groups. Importantly, all AEs were manageable and acceptable, with no grade 5 AEs reported in either group. CONCLUSION: HTA significantly improved overall survival compared to HL in patients with advanced HCC, with manageable safety profiles.