We retrospectively evaluated 338 patients with unresectable HCC who had undergone
lenvatinib or
sorafenib treatment between January 2018 and August 2020. Propensity-score matching analysis was performed with a 1:2 ratio to reduce the real-life baseline difference between the two groups.
RESULTS: A total of 210 patients (Male/Female: 150/60, mean age: 65.8 years) were recruited including 70 patients in the
Lenvatinib group and 140 patients in the
Sorafenib group. Compared with
sorafenib,
lenvatinib had significantly longer progression-free survival (PFS) (5.2 vs 3.3 months, p=0.019) but similar OR (13.3 vs 11.8 months, p=0.714). Additionally,
lenvatinib had better disease control rates (62.3 vs 48.6%, p=0.029) and equivalent incidences of treatment-related adverse events over
sorafenib. In multivariate analysis,
lenvatinib was associated with better PFS over
sorafenib (hazard ratio: 0.49, 95% confidence interval: 0.3-0.79, p=0.004) after adjustments of
albumin-
bilirubin grade and
alpha-fetoprotein level; however, different agents using
lenvatinib or
sorafenib did not contribute to OS, whether in univariate or multivariate analysis. Patients who failed
lenvatinib had a lower proportion of having sequential systemic
therapies compared with the
Sorafenib group (36.2 vs 47.8%, p=0.02). The most frequently used sequential
therapy following
lenvatinib and
sorafenib was
chemotherapy (n=9, 42.8%) and
regorafenib (n=33, 50.8%), respectively.
CONCLUSIONS: In clinical real-life practice,
lenvatinib illustrated promising survival benefits and acceptable safety for patients with unresectable HCC, while reducing the risk of
progression disease compared with
sorafenib. Additionally, lack of approved post-
lenvatinib systemic
therapies is a serious issue in the real world.