Effectiveness of Lenvatinib Versus Sorafenib for Unresectable Hepatocellular Carcinoma in Patients with Hepatic Decompensation

Park, Min Kyung; Lee, Yun Bin; Moon, Hyemi; Choi, Narak; Kim, Minseok Albert; Jang, Heejoon; Nam, Joon Yeul; Cho, Eun Ju; Lee, Jeong-Hoon; Yu, Su Jong; Kim, Yoon Jun; Yoon, Jung‐Hwan

doi:10.1007/s10620-021-07365-9

Cited by 9 publications

(23 citation statements)

References 25 publications

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“…Of the 24 studies included, one was a phase III randomized controlled trial (RCT) [ 8 ], and the other 23 were retrospective studies [ 8 , 9 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ], involving 2438 patients with unresectable HCC who received first-line treatment with lenvatinib. The initial dose of oral lenvatinib was 12 mg QD for patients with a body weight of ≥60 kg, or 8 mg QD for those with a body weight of <60 kg.…”

Section: Resultsmentioning

confidence: 99%

“…The initial dose of oral lenvatinib was 12 mg QD for patients with a body weight of ≥60 kg, or 8 mg QD for those with a body weight of <60 kg. Of the 23 studies that assessed the tumor response, nineteen studies [ 9 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 22 , 23 , 24 , 25 , 27 , 28 , 31 , 32 , 33 , 34 , 35 ] applied the mRECIST, one [ 32 ] applied the RECIST 1.1, one [ 21 ] applied the RECIST 1.1 and mRECIST, and two [ 26 , 30 ] were unknown. Details of all studies and the characteristics of the patients are presented in Table 1 .…”

Section: Resultsmentioning

confidence: 99%

“…Our study showed that the pooled median OS was 11.36 months, which is worse than the result of the previous phase III clinical trial [ 8 ]. The possible reason is due to the presence of patients with Child–Pugh class C in some of our included studies [ 9 , 21 , 33 ]. When we excluded these studies for subgroup analysis, the result showed that the pooled median OS was 12.90 months ( Supplementary Figure S11 ).…”

Section: Discussionmentioning

confidence: 99%

“…This obvious change also indirectly suggests that liver function is an important factor affecting the anti-tumor efficacy of lenvatinib. Regarding the survival benefit of lenvatinib in patients with hepatic decompensation (Child–Pugh class B and C), Park et al reported a worse median OS (1.5 months) in the untreated group versus the lenvatinib group (4.2 months), which still could not prove the survival benefit of lenvatinib due to patient selection bias [ 9 ]. As with sorafenib, the first approved systemic agent for advanced HCC, lenvatinib is also recommended with caution in patients with hepatic decompensation due to the unsatisfactory survival benefits [ 36 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, as most data are based on small single-center series, it is difficult to reach a consensus. In addition, the results of comparative studies of lenvatinib versus sorafenib are conflicting [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

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Lenvatinib as First-Line Treatment for Unresectable Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis

Wang

et al. 2022

Cancers

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Lenvatinib was approved in 2018 as a first-line treatment for patients with unresectable hepatocellular carcinoma (HCC). This systematic review and meta-analysis aimed to provide the most updated evidence about the efficacy and safety of lenvatinib as a first-line treatment for unresectable HCC. An electronic search of the PubMed database, Web of Science, Embase, and Cochrane Library was undertaken to identify all relevant studies up to May 2022. The pooled effect sizes were calculated based on the random-effects model. One phase III randomized controlled trial and 23 retrospective studies of 2438 patients were eligible for analysis. For patients treated with lenvatinib as first-line treatment, the pooled median overall survival (OS), median progression-free survival (PFS), 1-year OS rate, 1-year PFS rate, objective response rate (ORR), and disease control rate (DCR) were 11.36 months, 6.68 months, 56.0%, 27.0%, 36.0% and 75.0%, respectively. Lenvatinib showed a significantly superior efficacy compared with sorafenib (HR for OS, 0.85 and HR for PFS, 0.72; OR for ORR, 4.25 and OR for DCR, 2.23). The current study demonstrates that lenvatinib can provide better tumor responses and survival benefits than sorafenib as a first-line treatment for unresectable HCC, with a comparable incidence of adverse events.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Lenvatinib as First-Line Treatment for Unresectable Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis

Wang

et al. 2022

Cancers

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Efficacy of lenvatinib versus sorafenib in the primary treatment of advanced hepatocellular carcinoma: A meta‐analysis

Jaiswal,

Hameed,

Naz

et al. 2023

JGH Open

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Background and AimMolecular‐targeted agents such as lenvatinib and sorafenib have been approved to treat hepatocellular carcinoma (HCC). However, the choice between these two agents in the primary treatment for advanced HCC is still under debate with conflicting results. We sought to evaluate the efficacy of lenvatinib and sorafenib in patients with HCC.MethodsWe performed a systematic literature search using PubMed, Embase, and Scopus for relevant articles from inception until February 10, 2023. The primary outcome of this meta‐analysis was overall survival (OS). The secondary outcomes were progression‐free survival (PFS), time to progression, objective response rate (ORR), and disease control rate (DCR).ResultsA total of 13 studies with 3705 patients (1635 on lenvatinib and 2070 on sorafenib) were included in our analysis. The mean age of the patients in both groups was comparable (66.81 vs 65.9 years). Pooled analysis of primary outcomes showed that, compared with sorafenib, lenvatinib was associated with significantly better OS in patients treated with these drugs (HR 0.82, 95% CI: 0.69–0.97, P = 0.02). Pooled analysis also showed that PFS (HR 0.67, 95% CI: 0.57–0.78, P < 0.00001) and time to progression (HR 0.49, 95% CI: 0.31–0.79; P = 0.004) were significantly better in the lenvatinib group compared to the sorafenib group. It also showed that the lenvatinib group had significantly better ORR (odds ratio [OR] 5.43, 95% CI: 3.71–7.97; P < 0.00001) and DCR (OR 2.35, 95% CI: 1.75–3.16; P < 00001) than the sorafenib group.ConclusionOur study shows that lenvatinib is superior to sorafenib regarding OS and PFS in patients with advanced HCC.

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Efficacy and safety of HAIC alone vs. HAIC combined with lenvatinib for treatment of advanced hepatocellular carcinoma

Long

Chen

et al. 2023

Med Oncol

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To investigate e cacy and safety of hepatic arterial infusion chemotherapy combined with lenvatinib(HAIC-Len) and HAIC alone for the treatment of advanced hepatocellular carcinoma(Ad-HCC). MethodsTotally 349 patients with Ad-HCC participated in the research from February 2018 to October 2020. On the basis of propensity score matching(PSM), 132 and 110 cases were assigned to the HAIC group and the HAIC-Len group, respectively, with a ratio of 1:1. Progression-free survival(PFS), overall survival(OS), and complications were compared between two groups. The Kaplan-Meier method and log-rank test were utilized to estimate cumulative OS and PFS. Additionally, uni-and multi-variate Cox regression models were employed to identify signi cant independent factors. ResultsThe median follow-up period in this study was set to be 20.8 months. Following PSM, the one-, two-and three-year cumulative OS rates in the HAIC-Len and HAIC groups were 63.6%, 12.1%, and 3.0%, and 47.2%, 11.8%, and 2.7%, respectively, with a signi cant difference (P < 0.001). The rst-three-year cumulative incidence rates PFS in the HAIC-Len and the HAIC groups were 15.2%, 1.5%, and ND, and 11.8%, 4.5%, and 3.6%, respectively, with no signi cant difference detected(P = 0.092). BMI (HR: 0.709. 95% CI: 0.549, 0.915. P = 0.008) and AST(HR: 1.005. 95% CI: 1.003, 1.007. P < 0.001) represented independent prognostic factors for OS. Additionally, the two groups exhibited no signi cant difference in the incidence rates of adverse events. ConclusionsHAIC-Len signi cantly improved survival outcomes of patients with Ad-HCC and demonstrated acceptable toxicity compared to HAIC alone.

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Effectiveness of Lenvatinib Versus Sorafenib for Unresectable Hepatocellular Carcinoma in Patients with Hepatic Decompensation

Cited by 9 publications

References 25 publications

Lenvatinib as First-Line Treatment for Unresectable Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis

Lenvatinib as First-Line Treatment for Unresectable Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis

Efficacy of lenvatinib versus sorafenib in the primary treatment of advanced hepatocellular carcinoma: A meta‐analysis

Efficacy and safety of HAIC alone vs. HAIC combined with lenvatinib for treatment of advanced hepatocellular carcinoma

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