{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T07:39:49Z","timestamp":1790840389769,"version":"4.1.0"},"reference-count":22,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,11,19]],"date-time":"2024-11-19T00:00:00Z","timestamp":1731974400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>The relative superiority of atezolizumab\u2013bevacizumab versus pembrolizumab-lenvatinib in treatment of unresectable hepatocellular carcinoma (HCC) remains uncertain. This study aims to compare the efficacy of atezolizumab\u2013bevacizumab and pembrolizumab-lenvatinib in first-line treatments for unresectable HCC.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A total of 72 patients receiving pembrolizumab-lenvatinib (PL group) and 92 patients receiving atezolizumab-bevacizumab (AB group) between January 2019 and June 2023 were included in this study. By employing propensity score matching (PSM), we compared the overall survival (OS) and progression-free survival (PFS) between the two groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>After PSM, the 1-, 2-, and 3-year OS rates were 70.4%, 54.5%, and 40.0% in the PL group, and 88.4%, 44.2%, and 44.2% in the AB group, respectively. The 6-, 12-, and 18-month PFS rates were 56.9%, 43.0%, and 32.1% in the PL group, and 74.2%, 40.9%, and 30.7% in the AB group, respectively. No significant differences were observed in both OS (HR, 0.498; 95% CI, 0.217-1.143; <jats:italic>P<\/jats:italic> = 0.1) and PFS (HR, 0.913; 95% CI, 0.512-0.1.629; <jats:italic>P<\/jats:italic> = 0.758) between the two groups. Through subgroup analysis, we developed a Cirrhosis-Portal vein invasion-ALBI (CPA) score and identified that the AB group exhibited significantly longer OS than the PL group in the CPA high population (HR, 0.219; 95% CI, 0.075\u20130.637; <jats:italic>P<\/jats:italic> = 0.005). The treatment-related adverse events between the PL group and the AB group were comparable.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This study suggests that the efficacy of pembrolizumab-lenvatinib and atezolizumab-bevacizumab is comparable in first-line treatment of unresectable HCC, the atezolizumab-bevacizumab combination may confer additional benefits for patients with high CPA scores compared to pembrolizumab-lenvatinib.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fimmu.2024.1472870","type":"journal-article","created":{"date-parts":[[2024,11,19]],"date-time":"2024-11-19T06:15:20Z","timestamp":1731996920000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["Efficacy and safety of atezolizumab\u2013bevacizumab vs pembrolizumab-lenvatinib in unresectable hepatocellular carcinoma: a retrospective, cohort 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