Clinical Features and Outcomes of Conversion Therapy in Patients with Unresectable Hepatocellular Carcinoma

SIMPLE SUMMARY: Conversion therapy has shown potential for improving the prognosis of patients with unresectable hepatocellular carcinoma (u-HCC). However, information on the characteristics and outcomes of patients undergoing conversion therapy is lacking. We examined 244 patients with u-HCC treated with lenvatinib (LEN) and atezolizumab + bevacizumab (Atezo + Bev). Of the 244 patients, 12 (4.9%) underwent conversion therapy, six out of 131 (4.6%) were treated with LEN, and six out of 113 (5.3%) were treated with Atezo + Bev. Eleven patients (91.7%) with a modified albumin bilirubin (mALBI) grade 1 or 2a and BCLC-B stage showed significantly higher rates of transition to conversion therapy (p < 0.05). Among the patients with u-HCC who were treated with LEN and Atezo + Bev, those with mALBI 1+2a and BCLC-B were likely to achieve conversion therapy with downstaging. The outcomes of the patients undergoing conversion therapy are promising. ABSTRACT: This retrospective multicenter study analyzed 244 patients with unresectable hepatocellular carcinoma treated with lenvatinib (LEN) and atezolizumab + bevacizumab (Atezo + Bev) to examine the characteristics, treatment courses, and prognoses. The cases of patients who could achieve HCC downstaging from Barcelona Clinic Liver Cancer (BCLC) stage B or C to A or zero indicated the need for conversion therapy. The patients’ prognoses with and without conversion therapy were compared. Of the 244 patients, 12 (4.9%) underwent conversion therapy, six out of 131 (4.6%) were treated with LEN, and six out of 113 (5.3%) were treated with Atezo + Bev. Eleven patients (91.7%) with a modified albumin bilirubin (mALBI) grade 1 or 2a and BCLC-B stage showed significantly higher rates of transition during conversion therapy (p < 0.05). The patients undergoing conversion therapy had a significantly longer median overall survival rate than those receiving chemotherapy alone (1208 [1064–NA] vs. 569 [466–704] days, p < 0.01). A comparison of the patients who achieved a partial response with and without conversion was evaluated using propensity score matching to reduce the confounding factors, showing a significant survival benefit in the conversion group (1208 [1064–NA] vs. 665 days, p < 0.01). Among the patients with u-HCC who were treated with LEN and Atezo + Bev, those with mALBI 1 + 2a and BCLC-B were likely to achieve conversion therapy with downstaging.