Lenvatinib versus Sorafenib as first‐line treatment in hepatocellular carcinoma: A multi‐institutional matched case‐control study

Abstract

Background: Advanced Hepatocarcinoma (HCC) is an important health problem worldwide. Recently, the REFLECT trial demonstrated the non-inferiority of Lenvatinib compared to Sorafenib in I line setting, thus leading to the approval of new first-line standard of care, along with Sorafenib. Aims and methods:With aim to evaluate the optimal choice between Sorafenib and Lenvatinib as primary treatment in clinical practice, we performed a multicentric analysis with the propensity score matching on 184 HCC patients. Results:The median overall survival (OS) were 15.2 and 10.5 months for Lenvatinib and Sorafenib arm, respectively. The median progression-free survival (PFS) was 7.0 and 4.5 months for Lenvatinib and Sorafenib arm, respectively. Patients treated with Lenvatinib showed a 36% reduction of death risk (p = 0.0156), a 29% reduction of progression risk (p = 0.0446), a higher response rate (p < 0.00001) and a higher disease control rate (p = 0.002). Sorafenib showed to be correlated with more handfoot skin reaction and Lenvatinib with more hypertension and fatigue. We highlighted the prognostic role of Barcelona Clinic Liver Cancer (BCLC) stage, Eastern Cooperative Oncology Group Performance Status (ECOG-PS), bilirubin, alkaline

Comparison of atezolizumab plus bevacizumab and lenvatinib in terms of efficacy and safety as primary systemic chemotherapy for hepatocellular carcinoma

“…These results are similar to ours. As for prognosis, the median OS in real‐world studies conducted to date, including our study, ranged from 14.9 to 21.8 months, and these values are all longer than the median OS reported in the REFLECT trial 2,18–20 . As was the case with studies of atezolizumab plus bevacizumab, these differences may be attributable to differences in the proportions of patients in different BCLC stages at baseline.…”

“…As was the case with studies of atezolizumab plus bevacizumab, these differences may be attributable to differences in the proportions of patients in different BCLC stages at baseline. In the REFLECT trial, 21.8% of patients were at BCLC stage B at baseline, in the clinical practice studies, 39.1%–60.6% of patients were at BCLC stage A or B at baseline 2,18–20 . In the REFLECT trial, patients with Child‐Pugh class B, main portal vein or bile duct invasion, or more than 50% of liver occupation by intrahepatic tumor were excluded, whereas some patients included in the Len group in the present study met one or more of the aforementioned criteria.…”

“…As for prognosis, the median OS in real-world studies conducted to date, including our study, ranged from 14.9 to 21.8 months, and these values are all longer than the median OS reported in the REFLECT trial. 2,[18][19][20] As was the case with studies of atezolizumab plus bevacizumab, these present study met one or more of the aforementioned criteria.…”

“…Furthermore, our Len group had an ORR of 52.4% and a DCR of 82.5% according to mRECIST. In the previous real-world studies, the median PFS for patients with HCC receiving lenvatinib as primary -635 systemic chemotherapy ranged from 5.3 to 10.0 months [18][19][20] Furthermore, according to mRECIST, the ORRs ranged from 31.5% to 42.3%, and the DCRs ranged from 69.9% to 78.8%. [18][19][20] These results are similar to ours.…”

“…In the previous real-world studies, the median PFS for patients with HCC receiving lenvatinib as primary -635 systemic chemotherapy ranged from 5.3 to 10.0 months [18][19][20] Furthermore, according to mRECIST, the ORRs ranged from 31.5% to 42.3%, and the DCRs ranged from 69.9% to 78.8%. [18][19][20] These results are similar to ours. As for prognosis, the median OS in real-world studies conducted to date, including our study, ranged from 14.9 to 21.8 months, and these values are all longer than the median OS reported in the REFLECT trial.…”