Comparison of therapeutic outcomes of sorafenib and lenvatinib as primary treatments for hepatocellular carcinoma with a focus on molecular‐targeted agent sequential therapy: A propensity score‐matched analysis

Abstract

Aim The optimal choice between sorafenib (SOR) or lenvatinib (LEN) as the first‐line treatment for unresectable hepatocellular carcinoma (u‐HCC) remains debatable. Using propensity score matching, this study compares the outcomes of SOR and LEN in the molecular‐targeted agent (MTA) sequential treatment of u‐HCC patients. Methods This retrospective, multicenter, observational study recruited 137 u‐HCC patients who underwent primary treatment with LEN (n = 52) or SOR (n = 85) between June 2017 and June 2020 after regorafenib was approved as the secondary treatment for u‐HCC. Propensity score matching was used to reduce confounding, resulting in the selection of 104 patients (n = 52 for the SOR and LEN cohorts). Results The median overall survival was 21.8 months for LEN and 20.4 months for SOR. LEN exhibited significantly greater therapeutic efficacy as compared to SOR (objective response rate: 3.8% [SOR] vs. 42.3% [LEN], p < 0.01; progression‐free survival: 10 months [LEN] vs. 5.1 months [SOR], p < 0.01). No significant intergroup differences were noted in the rate of transition to secondary MTA treatments (SOR: 58.7%; LEN: 48.4%), adverse events (SOR: 86%; LEN: 95%), and maintenance of the Child–Pugh (CP) score during treatment. Compared to non‐MTA treatments, secondary MTA treatment achieved a greater improvement in survival (4.3 vs. 2.8 months, p = 0.0047). Multivariate analysis demonstrated that the CP score (p < 0.01) and alpha‐fetoprotein level (p < 0.01) were independent prognostic factors. Conclusions Both SOR and LEN treatments showed a clinically comparable therapeutic efficacy as the first‐line treatments for u‐HCC patients in an MTA sequential therapy.

Therapeutic efficacy of lenvatinib in nonviral unresectable hepatocellular carcinoma

“…Hepatic reserve function and portal vein invasion at treatment initiation are general prognostic factors for u‐HCC treatment with MTAs, 32,47 and they were also found to be prognostic factors in our study; however, the hepatic function was observed only in PFS and not in OS analysis. This may be due to the limitation of this study described below.…”

Comparative study between sorafenib and lenvatinib as the first‐line therapy in the sequential treatment of unresectable hepatocellular carcinoma in a real‐world setting

“…Additionally, another study from Japan compared the clinical results of sorafenib and lenvatinib PSM. 25 However, that study included Child-Pugh class A cases alone. As our study aimed to reflect real-world data, we included Child-Pugh B patients.…”

The Combination of Albumin–Bilirubin Score and Prothrombin Time Is a Useful Tool for Predicting Liver Dysfunction after Transcatheter Arterial Chemoembolization in Child–Pugh Class A Patients with Hepatocellular Carcinoma within Up-to-Seven Criteria

“…In fact, in the present study, 12.7% of the patients with HCC within up-to-seven criteria exhibited a decline in liver function from Child–Pugh class A to class B after TACE. Furthermore, previous studies have reported that the treatment efficiency of MTAs is associated with liver function [ 5 , 9 , 23 ] and that the use of MTAs improves the prognosis of advanced HCC compared with TACE [ 6 ].…”

“…Recent studies have reported that for patients with HCC beyond up-to-seven criteria [ 6 , 8 ], treatment with MTAs is recommended as the treatment efficiency of TACE for HCC beyond up-to-seven criteria is poor [ 6 ] and TACE increases the decline in liver function [ 5 , 6 ]. Other studies have reported that the treatment efficiency of MTAs depends on liver function [ 5 , 9 ].…”