TACE Plus Lenvatinib Versus TACE Plus Sorafenib for Unresectable Hepatocellular Carcinoma With Portal Vein Tumor Thrombus: A Prospective Cohort Study

Yang, Baoqi; Luo, Jie; Yang, Ting; Chen, Mingyang; Gao, Yuemei; Zhang, Tian; Zhang, Yuzu; Wu, Hao; Liao, Zhengyin

doi:10.3389/fonc.2021.821599

Cited by 34 publications

(52 citation statements)

References 24 publications

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“…Whether lenvatinib plus TACE has advantages over sorafenib plus TACE is the subject of this section. Three studies with a total of 292 people were included (42)(43)(44). Two of them were prospective studies that explored the effect of TACE plus lenvatinib or sorafenib for patients with uHCC with PVTT (43,44) and one propensity score matching retrospective study that addressed TACE with drug-eluting beads plus lenvatinib vs. sorafenib for advanced HCC (42).…”

Section: Therapeutic Responses Of Lenvatinib Plus Tace Therapy Versus...mentioning

confidence: 99%

“…The response assessments were reported based on mRECIST. The ORR (CR + PR) of the sorafenib plus TACE (42,44). Although Ding et al reported no significant difference in OS between the two groups, the median OS for patients with advanced HCC including main PVTT receiving lenvatinib plus TACE was 14.5 months, which was longer than 13.6 months in the REFLECT trial (43).…”

Section: Objective Response Ratementioning

confidence: 99%

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Lenvatinib plus transarterial chemoembolization with or without immune checkpoint inhibitors for unresectable hepatocellular carcinoma: A review

Sun

Xu²,

Meng

et al. 2022

Front. Oncol.

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Lenvatinib plus transarterial chemoembolization (TACE)have become the first choice for patients with hepatocellular carcinoma (HCC) that are unsuitable for TACE. Sorafenib plus TACE therapy for patients with portal vein tumor thrombus (PVTT) achieved positive results. However, Lenvatinib plus TACE appeared to achieve a more advantageous result for these patients based on the phase 3 REFLECT trial. Both TACE and lenvatinib therapy have immune-stimulating effects, so would lenvatinib plus TACE and immune checkpoint inhibitors be an advantageous therapy for unresectable HCC (uHCC)? Thirteen articles from PubMed were explored to determine the efficacy and safety of lenvatinib plus TACE with or without PD-1 inhibitors therapy. Most of the adverse events (AEs) were manageable. Lenvatinib plus TACE therapy was superior to lenvatinib monotherapy with intermediate stage HCC especially beyond up-to-seven criterion and was superior to TACE monotherapy in patients with uHCC or sorafenib plus TACE therapy in patients with PVTT. Objective response rates (ORRs) of 53.1%–75%, median progression free survival (PFS) of 6.15–11.6 months, and median overall survival (OS) of 14.5–18.97 months were achieved in the lenvatinib plus TACE group. Levatinib plus TACE and PD-1 inhibitors achieved ORRs of 46.7% –80.6%, median PFS of 7.3–13.3 months, and median OS of 16.9–24 months. Control studies also confirmed the triple therapy was superior to lenvatinib plus TACE in patients with uHCC. Overall, the triple therapy is a promising treatment for patients with uHCC, including main PVTT and extrahepatic metastasis. Lenvatinib plus TACE therapy was also preferable for intermediate stage HCC beyond up-to-seven criterion and for patients with PVTT.

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Section: Therapeutic Responses Of Lenvatinib Plus Tace Therapy Versus...mentioning

confidence: 99%

Section: Objective Response Ratementioning

confidence: 99%

Lenvatinib plus transarterial chemoembolization with or without immune checkpoint inhibitors for unresectable hepatocellular carcinoma: A review

Sun

Xu²,

Meng

et al. 2022

Front. Oncol.

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“…To date, few studies have reported the clinical outcomes of TACE‐lenvatinib versus TACE‐sorafenib for the treatment of HCC patients 17,18 . The main differences between the present study and these previous studies are as follows (Supplementary Table ).…”

Section: Discussionmentioning

confidence: 75%

Transarterial chemoembolization combined with lenvatinib versus transarterial chemoembolization combined with sorafenib for unresectable hepatocellular carcinoma: A comparative retrospective study

Zhang

Chen

Zhou

et al. 2022

Hepatology Research

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Aim Tyrosine kinase inhibitors target transarterial chemoembolization (TACE)‐mediated vascular endothelial growth factor to inhibit tumor revascularization and to slow tumor progression. The present study aimed to compare the clinical outcomes of TACE combined with lenvatinib (TACE‐lenvatinib) and TACE combined with sorafenib (TACE‐sorafenib) in patients with unresectable hepatocellular carcinoma (HCC). Methods The clinical data of patients diagnosed with unresectable HCC who received TACE‐lenvatinib or TACE‐sorafenib between January 2018 and April 2021 were retrospectively reviewed. The tumor response, progression‐free survival (PFS), overall survival (OS), and adverse events (AEs) were evaluated and compared between the two groups. Results A total of 112 patients were enrolled and classified into the TACE‐lenvatinib group (n = 53) and the TACE‐sorafenib group (n = 59). The objective response rates of patients in the TACE‐lenvatinib and TACE‐sorafenib groups were 54.7% and 44.1%, respectively (p = 0.260), and the disease control rates (DCRs) were 81.1% and 61.0% (p = 0.020). The median PFS time was significantly longer in the TACE‐lenvatinib group than in the TACE‐sorafenib group (10.7 vs. 6.0 months; p = 0.002). The median OS time between the TACE‐lenvatinib and TACE‐sorafenib groups also showed a significant difference (30.5 vs. 20.5 months, p = 0.018). All treatment‐related AEs and grade 3/4 AEs were comparable between the two groups (p > 0.05). Conclusion Compared to TACE‐sorafenib, TACE‐lenvatinib was associated with better DCR, PFS and OS outcomes in patients with unresectable HCC. In subgroups of Barcelona Clinic Liver Cancer B stage or TACE‐refractory patients, TACE‐lenvatinib also showed a trend of superiority.

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“…TACE is generally contraindicated when there is a tumour thrombosis in main trunk or first branch of portal vein. Recent studies increasingly focused on the TACE and combination therapy in unresectable patients with Vp III and Vp IV 31 . Even for those with tumour thrombosis in main trunk or first branch of portal vein, the treatment was well tolerated.…”

Section: Discussionmentioning

confidence: 99%

Conversion therapy for initially unresectable hepatocellular carcinoma using a combination of toripalimab, lenvatinib plus TACE: real-world study

Ding

et al. 2022

BJS Open

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Background Combination conversion therapies afforded curative surgery chance for initially unresectable hepatocellular carcinoma (uHCC). This study aimed to evaluate the conversion rate and clinical outcomes of a first-line conversion regimen of lenvatinib combined with transarterial chemoembolization (TACE) plus immunotherapy for initial uHCC by interpreting real-world data. Methods Conversion therapy data of patients with uHCC from November 2018 to January 2021 were analysed. The regimens included triple combination therapy (t-CT: lenvatinib, TACE, plus toripalimab) and dual combination therapy (d-CT: lenvatinib plus TACE). Another study population diagnosed with hepatocellular carcinoma of macrovascular invasion disease were included as the upfront surgery cohort. Treatment responses and conversion rate were primary outcomes. Survival and adverse events were analysed. Results Fifty-one patients receiving t-CT (n = 30) and d-CT (n = 21) were enrolled. Higher overall response rates (76.7 per cent versus 47.6 per cent, P = 0.042) and disease control rates (90.0 per cent versus 57.1 per cent, P = 0.042) were observed via t-CT than d-CT. Both median overall survival and event-free survival were not reached in the t-CT cohort. A higher rate of curative conversion resection was achieved through t-CT than d-CT (50.0 per cent versus 19.0 per cent, P = 0.039). The disease-free survival of patients undergoing conversion resection in the t-CT cohort (n = 15) was higher than that in the upfront surgery cohort (n = 68, P = 0.039). Both t-CT and d-CT regimens were tolerable. Conclusions Better treatment responses and conversion rate for patients with uHCC were obtained with first-line t-CT. Neoadjuvant t-CT before surgery should be recommended for patients with macrovascular invasion.

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TACE Plus Lenvatinib Versus TACE Plus Sorafenib for Unresectable Hepatocellular Carcinoma With Portal Vein Tumor Thrombus: A Prospective Cohort Study

Cited by 34 publications

References 24 publications

Lenvatinib plus transarterial chemoembolization with or without immune checkpoint inhibitors for unresectable hepatocellular carcinoma: A review

Lenvatinib plus transarterial chemoembolization with or without immune checkpoint inhibitors for unresectable hepatocellular carcinoma: A review

Transarterial chemoembolization combined with lenvatinib versus transarterial chemoembolization combined with sorafenib for unresectable hepatocellular carcinoma: A comparative retrospective study

Conversion therapy for initially unresectable hepatocellular carcinoma using a combination of toripalimab, lenvatinib plus TACE: real-world study

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