Lenvatinib versus sorafenib in first‐line treatment of unresectable hepatocellular carcinoma: An inverse probability of treatment weighting analysis

Abstract

Purpose Data from common clinical practice were used to generate balanced cohorts of patients receiving either sorafenib or lenvatinib, for unresectable hepatocellular carcinoma, with the final aim to investigate their declared equivalence. Methods Clinical features of lenvatinib and sorafenib patients were balanced through inverse probability of treatment weighting (IPTW) methodology, which weights patients’ characteristics and measured outcomes of each patient in both treatment arms. Overall survival was the primary endpoint and occurrence of adverse events was the secondary. Results The analysis included 385 patients who received lenvatinib, and 555 patients who received sorafenib. In the unadjusted cohort, lenvatinib did not show a survival advantage over sorafenib (HR: 0.85, 95% CI 0.70‐1.02). After IPTW adjustment, lenvatinib still not returned a survival advantage over sorafenib (HR: 0.82, 95% CI: 0.62‐1.07) even in presence of balanced baseline characteristics. Lenvatinib provided longer survival than sorafenib in patients previously submitted to TACE (HR: 0.69), with PS of 0 (HR: 0.73) or without extrahepatic disease (HR: 0.69). Conclusion Present results confirmed randomized controlled trial in the real‐life setting, but also suggests that in earlier stages some benefit can be expected.

CYP2C8 Suppress Proliferation, Migration, Invasion and Sorafenib Resistance of Hepatocellular Carcinoma via PI3K/Akt/p27kip1 Axis

“… 33 , 34 However, the resistance of sorafenib limits its long-term anticancereffect. The 1-year survival rate of unresectable HCC treated with sorafenib was less than 60%, and the median survival time is about 12 months, 35–37 which is far from satisfactory. The major neuronal isoform of RAF, BRAF and MEK pathways play a critical and central role in HCC escape from TKIs activity.…”

Identification of lenvatinib prognostic index via recursive partitioning analysis in advanced hepatocellular carcinoma

“…23,25 Data confirmed recently by our group, where lenvatinib provided longer survival than sorafenib in patients previously submitted to TACE. 26 Furthermore, some data are emerging about the role of lenvatinib even in an earlier setting, i.e. before TACE; 27 indeed, systemic treatment may be preferred when intermediate-stage HCC is deemed TACEunsuitable, i.e.…”

Sorafenib and Lenvatinib as first‐line treatment of hepatocellular carcinoma: A still controversial comparison

“…I read with interest the study by Casadei-Gardini et al who compared the effects of sorafenib and lenvatinib as first-line treatment of hepatocellular carcinoma (HCC) in the real-life setting, through inverse probability of treatment weighting (IPTW) methodology which weights patient characteristics and measured outcomes of each patient in both treatment arms. 1 They found that in the unadjusted cohort, lenvatinib did not show a survival advantage over sorafenib (HR: 0.85, 95% CI: 0.70-1.02). After IPTW adjustment, lenvatinib still not returned a survival advantage over sorafenib (HR: 0.82, 95% CI: 0.62-1.07) even in the presence of balanced baseline characteristics.…”