Clinical impact of lenvatinib in patients with unresectable hepatocellular carcinoma who received sorafenib

Abstract

Background Lenvatinib has been approved for use in the systemic treatment for unresectable hepatocellular carcinoma (HCC). This study aimed to investigate the efficacy and safety of lenvatinib in patients with unresectable HCC who received sorafenib. Methods A total of 40 patients who received lenvatinib after sorafenib were retrospectively identified: as second line in 20 patients, third line in 10 patients, and fourth line and later lines in 10 patients. The treatment response to lenvatinib was determined in accordance with the guidelines of the modified Response Evaluation Criteria in Solid Tumors (mRECIST) every 2–3 months after commencement of lenvatinib. Results Median progression-free survival (PFS) and median overall survival (OS) of the whole population were 3.3 and 9.8 months, respectively. The objective response rate was 27.5%. Univariate and multivariate analyses showed that alpha-fetoprotein level >400 ng/mL was an independent prognostic factor of worse PFS and OS. The clinical outcomes of lenvatinib therapy as second-line, third-line, or fourth line and later line treatment were similar, and previous response to sorafenib could predict the response to subsequent lenvatinib. Most adverse events were grades 1–2, and the majority of patients tolerated the side effects. Our study confirms the efficacy and safety of lenvatinib as second-line and later line treatment for patients with unresectable HCC who received sorafenib in clinical practice.

Efficacy and Safety of Lenvatinib in Hepatocellular Carcinoma Patients with Liver Transplantation: A Case-Control Study

“…Lenvatinib was started at a targeted dose of 10 mg once daily for each patient; all patients had a body weight ≥ 60 kg, whether they were part of the LT group or the control group [ 22 , 25 ]. Patients visited the outpatient clinic every 2–4 weeks for assessment of AEs, hematological and biochemical tests, AFP, vital signs, physical examination, and body weight.…”

“…The SELECT trial, which focused on lenvatinib in patients with radioiodine-refractory thyroid cancer, showed no significant difference in survival between patients who experienced prior sorafenib treatment and those who did not [ 24 ]. We also published a cohort study to investigate the efficacy and safety of lenvatinib in patients with HCC who received sorafenib [ 25 ]. The ORR was 27.5%; the median PFS and OS were 3.3 months and 9.9 months, respectively, which was non-inferior to the second-line treatment of HCC, such as ramucirumab or regorafenib [ 26 , 27 ].…”

The Prognostic Value of Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio in Patients with Hepatocellular Carcinoma Receiving Atezolizumab Plus Bevacizumab

“…Several studies have confirmed the efficacy and safety of sorafenib and lenvatinib in patients with HCC [ 30 , 31 , 32 , 33 , 34 , 35 ]. Nevertheless, information on atezolizumab plus bevacizumab in real-world practice is relatively limited.…”

Evaluating the Effect of Lenvatinib on Sorafenib-Resistant Hepatocellular Carcinoma Cells

“…Chen et al enrolled 40 patients who received lenvatinib after sorafenib. The median overall survival (OS) was 9.8 months, and the objective response rate was 27.5%; moreover, the clinical outcomes of lenvatinib treatment in later lines were similar [ 15 ]. However, a report by Tomonari et al indicated that the objective response rate was 33.3% in the second line, and 20.0% in the third line.…”

“…Thus, lenvatinib has been approved as a first-line systemic treatment for unresectable advanced HCC. Further, some evidence indicates that lenvatinib may be used as a second-line treatment for patients who are intolerant to sorafenib or following sorafenib failure [ 14 , 15 , 16 ].…”