Therapeutic efficacy of lenvatinib as third-line treatment after regorafenib for unresectable hepatocellular carcinoma progression.

Abstract

AIM:

Multiple molecular agents have been developed for treating unresectable hepatocellular carcinoma. This study aimed to elucidate the clinical efficacy of sequential treatment with lenvatinib after regorafenib failure.

METHODS:

From June 2017 to October 2020, 63 patients with Child-Pugh A and treated with regorafenib followed by sorafenib were enrolled (median age 71 years, 52 men, Barcelona Clinic Liver Cancer B:C = 23:40). They were divided into two groups, those treated with lenvatinib after regorafenib treatment (R-L group, n = 47) and those who did not receive lenvatinib after regorafenib (non-R-L group, n = 16). Prognostic factors were retrospectively analyzed after adjustment with inverse probability weighting.

RESULTS:

Serum albumin level at the start of regorafenib and reasons for discontinuation of regorafenib were significantly different between the R-L and non-R-L groups, whereas the albumin-bilirubin score, Child-Pugh class, and tumor burden were not. Progression-free survival was also not significantly different (median 4.1 vs. 3.8 months, p = 0.586). As for overall survival, the R-L group showed better prognosis after introducing regorafenib and after introducing sorafenib, following inverse probability weighting adjustment (MST 19.7 vs. 10.3 months, 33.8 vs. 15.3 months, p < 0.001 and p = 0.022, respectively). Modified albumin-bilirubin grade 2b (score >-2.27) at the start of regorafenib (HR 2.074, p = 0.041) and the presence of lenvatinib treatment after regorafenib failure (HR 0.355, p = 0.004) were found to be significant prognostic factors in Cox proportional hazards multivariate analysis, after inverse probability weighting adjustment.

CONCLUSION:

These results show that lenvatinib is a good sequential treatment option after progression under regorafenib therapy in unresectable hepatocellular carcinoma patients with better hepatic reserve function.

• Authors: Atsushi Hiraoka, Takashi Kumada, Takeshi Hatanaka, Toshifumi Tada, Kazuya Kariyama, Joji Tani, Shinya Fukunishi, Masanori Atsukawa, Masashi Hirooka, Kunihiko Tsuji, Toru Ishikawa, Koichi Takaguchi, Ei Itobayashi, Kazuto Tajiri, Noritomo Shimada, Hiroshi Shibata, Hironori Ochi, Kazuhito Kawata, Satoshi Yasuda, Hidenori Toyoda, Ogawa Chikara, Tsutomu Tamai, Satoru Kakizaki, Hiroki Tojima, Tamon Nagashima, Takashi Ueno, Daichi Takizawa, Atsushi Naganuma, Hideko Ohama, Kazuhiro Nouso, Akemi Tsutsui, Takuya Nagano, Norio Itokawa, Tomomi Okubo, Taeang Arai, Michitaka Imai, Yohei Koizumi, Shinichiro Nakamura, Kouji Joko, Kojiro Michitaka, Yoichi Hiasa, Masatoshi Kudo, Real-life Practice Experts for HCC (RELPEC) Study Group, HCC 48 Group (hepatocellular carcinoma experts from 48 clinics in Japan), and GLSG (Gunma Liver Study Group)
• Journal: Hepatology research : the official journal of the Japan Society of Hepatology (Hepatol Res) Vol. 51 Issue 8 Pg. 880-889 (Aug 2021) ISSN: 1386-6346 [Print] Netherlands
• PMID: 33837620 (Publication Type: Journal Article)
• Copyright: © 2021 The Authors. Hepatology Research published by John Wiley & Sons Australia, Ltd on behalf of Japan Society of Hepatology.