Lenvatinib Plus PD-1 Inhibitors versus Regorafenib in Patients with Advanced Hepatocellular Carcinoma After the Failure of Sorafenib: A Retrospective Study

Abstract

Purpose To evaluate the clinical outcomes of lenvatinib plus PD-1 inhibitors (LP) and regorafenib (R) in patients with advanced hepatocellular carcinoma (HCC) after sorafenib failure. Methods From June 2018 to September 2021, 68 patients from a single center who received lenvatinib combined with PD-1 inhibitors or regorafenib after sorafenib treatment failure were analyzed. The tumor response and survival outcomes were compared between the LP group and R group. Prognostic factors for OS and PFS were determined using Cox proportional hazard regression models. Results The ORR increased in the LP group (19.5% vs 7.4%, p =0.294), and the DCR was better in the R group (73.2% vs 44.4%, p =0.017). Additionally, median PFS and OS were not significantly different between the LP group and R two groups in survival analysis (PFS: 5.3 months vs 3.0 months, p =0.633; OS: 11.8 months vs 8.0 months, p =0.699). The common adverse events (≥grade 3) were hand-foot skin reactions (13.1%). In multivariate analyses, AFP≥400 ng/mL and ECOG PS 2 were independent risk factors for poor prognosis. Conclusion The LP group appeared to have a trend of greater tumor response and a higher disease control rate than the R group among patients with sorafenib-resistant HCC, although PFS and OS did not differ significantly between the two groups.

New Opportunities in the Systemic Treatment of Hepatocellular Carcinoma—Today and Tomorrow

“…Recently, lenvatinib combined with immunotherapy (sintilimab, tislelizumab, pembrolizumab, and camrelizumab) has been compared to regorafenib as a post-sorafenib treatment strategy. The combination cohort demonstrated a trend toward improved outcomes and response rates, but the differences were not significant [116]. Moreover, a recent study evaluated the use of cadonlimab, a bispecific antibody simultaneously binding to CTLA-4 and PD1, in combination with lenvatinib as a first-line treatment in patients with advanced HCC.…”