S2560 Real-World Comparative Outcomes of Nivolumab + Ipilimumab Versus Atezolizumab + Bevacizumab in Advanced Hepatocellular Carcinoma: A TriNetx Study

Introduction: Hepatocellular carcinoma (HCC) is the second leading cause of cancer related death. Atezolizumab plus Bevacizumab (ATZ + BEV) has transformed the treatment landscape for advanced HCC and now a first-line option following the IMbrave150 trial. The Checkmate 040 randomized controlled trial has shown Nivolumab plus Ipilimumab (NIVO + IPI) has improved long-term survival benefit. This study aims to compare outcomes of both treatment modalities for advanced HCC. Methods: This is a retrospective cohort study utilizing the TriNetX database. Criteria included adult patients >18 years of age with Advanced HCC recently initiating (ATZ + BEV) or (NIVO + IPI). Outcomes include overall survival, most recent AFP, aspartate aminotransferase, alanine aminotransferase, Bilirubin, INR, and Platelet count levels. Time to AFP to reach 0-40 ng/ml. Risk of developing hepatic encephalopathy or coma, hospitalization, and adverse events. Propensity score matching (PSM) was performed for demographics, lab results, MELD and ECOG scores, and confounding comorbidities. Results were expressed as risk difference (RD) with 95% CI. Time to event endpoints using Kaplan-Meier curves and Cox proportional hazards models reported as hazard ratio (HR) and log-rank P values. Results: After matching, the cohort included 1979 patients in (ATZ + BEV) group and 1973 patients in (NIVO + IPI) group. (ATZ + BEV) showed significantly increased median survival 997 vs 504 days (HR 0.67, 95% CI 0.61–0.74 log-rank P < 0.0001). However mean AFP differed statistically (ATZ + BEV) 7,746 vs (NIVO + IPI) 17,495 P = 0.006. Time to normalization of AFP to below 40 was not significant, P = 0.196. (ATZ + BEV) recipients experienced high risk of inpatient visits (RD 2.08%, 95% CI -3.089,7.257, P = 0.43). The risk of developing predefined adverse events was similar between regimens with a nonsignificant RD. Conclusion: In this real-world matched cohort, (ATZ + BEV) conferred superior overall survival but was associated and greater healthcare utilization, while adverse event rates were comparable between treatments.