CRAFITY Score May Guide First-Line Therapy Selection in Unresectable HCC: Liver Cancer | June 2026

• Atezolizumab plus bevacizumab remains the most widely used first-line therapy for unresectable hepatocellular carcinoma, while lenvatinib continues to be an important alternative.

• This international multicenter study evaluated whether the CRAFITY score can help identify which patients may benefit more from one treatment over the other.

• The CRAFITY score is based on two simple biomarkers:

• CRP ≥1 mg/dL

• AFP ≥100 ng/mL

Patients receive a score of 0, 1, or 2.

• The analysis included 994 patients treated across Japan and Taiwan, making it one of the largest real-world comparisons of Atezo+Bev and lenvatinib stratified by CRAFITY score.

• In patients with CRAFITY score 0, progression-free survival and overall survival were similar between Atezo+Bev and lenvatinib.

• Similar results were observed in patients with CRAFITY score 1, suggesting both treatment options remain reasonable choices in this group.

• The key finding emerged in patients with CRAFITY score 2, representing the highest-risk subgroup.

• In CRAFITY-2 patients, lenvatinib achieved significantly longer progression-free survival compared with Atezo+Bev.

• This suggests that highly inflammatory, biologically aggressive HCC characterized by elevated CRP and AFP may respond less favorably to immunotherapy-based treatment.

• Overall survival did not differ significantly between the two treatment groups, but progression control clearly favored lenvatinib in the CRAFITY-2 population.

• The study demonstrated a significant interaction between CRAFITY score and treatment efficacy, supporting the concept of biomarker-driven treatment selection.

• One major advantage of the CRAFITY score is its simplicity. Both CRP and AFP are routinely available worldwide and do not require expensive molecular testing.

• These findings challenge the current “one-size-fits-all” approach in first-line HCC treatment and suggest that not every patient may derive the same benefit from Atezo+Bev.

• Before changing routine practice, prospective validation studies are required because this analysis was retrospective.

• Nevertheless, the study provides one of the strongest signals to date that a simple clinical biomarker score may help personalize first-line therapy in advanced HCC.

Bottom line: In unresectable HCC patients with a CRAFITY score of 2, lenvatinib achieved superior progression-free survival compared with atezolizumab plus bevacizumab, suggesting that CRAFITY may become a practical tool for first-line treatment selection.