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Multicenter Study
. 2024 Jul;30(3):345-359.
doi: 10.3350/cmh.2023.0553. Epub 2024 Mar 12.

Sorafenib vs. Lenvatinib in advanced hepatocellular carcinoma after atezolizumab/bevacizumab failure: A real-world study

Young Eun Chon  1 , Dong Yun Kim  2 , Mi Na Kim  2 , Beom Kyung Kim  2 , Seung Up Kim  2 , Jun Yong Park  2 , Sang Hoon Ahn  2 , Yeonjung Ha  1 , Joo Ho Lee  1 , Kwan Sik Lee  1 , Beodeul Kang  3 , Jung Sun Kim  3 , Hong Jae Chon  3 , Do Young Kim  2
Affiliations
Multicenter Study

Sorafenib vs. Lenvatinib in advanced hepatocellular carcinoma after atezolizumab/bevacizumab failure: A real-world study

Young Eun Chon et al. Clin Mol Hepatol. 2024 Jul.

Abstract

Background/aims: Atezolizumab plus bevacizumab (ATE+BEV) therapy has become the recommended first-line therapy for patients with unresectable hepatocellular carcinoma (HCC) because of favorable treatment responses. However, there is a lack of data on sequential regimens after ATE+BEV treatment failure. We aimed to investigate the clinical outcomes of patients with advanced HCC who received subsequent systemic therapy for disease progression after ATE+BEV.

Methods: This multicenter, retrospective study included patients who started second-line systemic treatment with sorafenib or lenvatinib after HCC progressed on ATE+BEV between August 2019 and December 2022. Treatment response was assessed using the Response Evaluation Criteria in Solid Tumors (version 1.1.). Clinical features of the two groups were balanced through propensity score (PS) matching.

Results: This study enrolled 126 patients, 40 (31.7%) in the lenvatinib group, and 86 (68.3%) in the sorafenib group. The median age was 63 years, and males were predominant (88.1%). In PS-matched cohorts (36 patients in each group), the objective response rate was similar between the lenvatinib- and sorafenib-treated groups (5.6% vs. 8.3%; P=0.643), but the disease control rate was superior in the lenvatinib group (66.7% vs. 22.2%; P<0.001). Despite the superior progression- free survival (PFS) in the lenvatinib group (3.5 vs. 1.8 months, P=0.001), the overall survival (OS, 10.3 vs. 7.5 months, P=0.353) did not differ between the two PS-matched treatment groups.

Conclusion: In second-line therapy for unresectable HCC after ATE+BEV failure, lenvatinib showed better PFS and comparable OS to sorafenib in a real-world setting. Future studies with larger sample sizes and longer follow-ups are needed to optimize second-line treatment.

Keywords: Atezolizumab; Bevacizumab; Hepatocellular carcinoma; Lenvatinib; Sorafenib.

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Conflict of interest statement

Conflicts of Interest

HJ Chon has received honoraria from Eisai, Roche, Bayer, ONO, MSD, BMS, Celgene, Sanofi, Servier, AstraZeneca, Sillajen, Menarini, GreenCross Cell, Boryung Pharmaceuticals, and Dong-A ST, and has received research grants from Roche, Dong-A ST, and Boryung Pharmaceuticals. The other authors have no potential conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
Flow chart of patient selection. HCC, hepatocellular carcinoma; ATE+BEV, atezolizumab plus bevacizumab.
Figure 2.
Figure 2.
Kaplan–Meier analysis of survival outcomes in overall patients treated with lenvatinib or sorafenib. (A) Overall survival (OS); (B) Progression-free survival (PFS).
Figure 3.
Figure 3.
Kaplan–Meier analysis of survival outcomes in PS-matched patients treated with lenvatinib or sorafenib. (A) Overall survival (OS); (B) Progression-free survival (PFS).
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