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

Abstract

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.

Transarterial chemoembolization combined with lenvatinib versus transarterial chemoembolization combined with sorafenib for unresectable hepatocellular carcinoma: A systematic review and meta-analysis

“…The characteristics of the six enrolled studies are presented in Table 1. Among them, one study was a single-center prospective RCT from China (17), whereas the other five studies were single-center or multicenter prospective or retrospective cohort studies which were conducted in China, Japan and Korea (15,16,(18)(19)(20). A total of 598 patients with uHCC were included, of which 261 patients were treated with LEN+TACE combination therapy, whereas 337 patients were treated with SOR+TACE.…”

“…In addition to sorafenib, other TKIs, including lenvatinib, regarofenib and cabozantinib, have been approved by the United States Food and Drug Administration (FDA) for the treatment of uHCC (14), and so a wide range of suitable combination treatment options are now available for patients. A comparative retrospective study (15) indicated that the median OS time was significantly longer in a lenvatinib plus TACE (LEN+TACE) treatment group compared with the sorafenib plus TACE (SOR+TACE) group (30.5 vs. 20.5 months; P = 0.018).…”

Evaluation of Lactate Dehydrogenase and Alkaline Phosphatase as Predictive Biomarkers in the Prognosis of Hepatocellular Carcinoma and Development of a New Nomogram

“… 33 Zhang et al found that the mOS of inoperable HCC patients receiving TACE-lenvatinib was 30.5 months. 34 In addition, Su et al confirmed that gamma knife radiosurgery has a superior OS compared to TACE in the treatment of PVTT-HCC. 35 Predicting the prognosis of HCC patients remains a formidable obstacle, despite the widespread use of numerous treatment methods in clinical practice.…”

Clinical Effect of Lenvatinib Re-Administration after Transcatheter Arterial Chemoembolization in Patients with Intermediate Stage Hepatocellular Carcinoma

“…In the protocol, Sorafenib was pre-administered 2,3 weeks before TACE, and then Sorafenib was re-administered after TACE, and the endpoint was time to untreatable (unTACEable) progression. In recent years, LEN-TACE sequential therapy was reported to improve the prognosis of unresectable HCC in comparison to LEN alone, TACE alone, or TACE-SOR [ 13 , 14 , 15 , 16 , 17 ]. These reports differed from our study in the background of the HCC BCLC stage or the comparison of the treatment method (drug, TACE, etc.).…”