Lenvatinib acts as the salvage therapy for advanced hepatocellular carcinoma

Abstract

Background: Hepatocellular carcinoma (HCC) is one of the most common causes of cancer death in the world. Sorafenib is the only molecular targeted agent approved as the first line therapy for advanced HCC. After failure of sorafenib, there are regorafenib and nivolumab being approved by the US Food and Drug Administration, but the price and side effects of these 2 drugs limit their clinical application. Recently, lenvatinib has showed higher response rate (RR) and better progression free survival (PFS) than sorafenib as the first line therapy for advanced HCC in a randomized phase III trial, but the therapeutic effect of lenvatinib after sorafenib is not clear. Methods: From Jul. 2017, we started to prescribe lenvatinib to patients with advanced HCC whose tumor progressed after sorafenib, who did not fit the indications of sorafenib or who could not tolerate with sorafenib. The initial dosage of lenvatinib was 10 mg daily. Tumor response was evaluated by the Response Evaluation Criteria in Solid Tumors 1.1. Time to treatment failure (TTF) was defined as the time from the start of lenvatinib to discontinuation for any reason, including disease progression, treatment toxicity, patient preference, or death. Overall survival (OS) was defined as the time from the start of lenvatinib to death. Clinical data and therapeutic effect were retrospectively collected and analyzed. Results: From Jul. 2017 to Feb. 2018, there were 30 cases of advanced HCC who received lenvatinib as the salvage therapy. No patient got complete response. Response rate was 26.7% (8/30), and disease control rate was 60% (RR +stable disease, 18/30). Previous resistance to sorafenib did not influence the response to lenvatinib. The median TTF was 3.7 months, median OS was 5.9 months and 6‐month survival rate was 53.8%. Side effects were mostly mild and manageable. Conclusions: From this real world experience, it showed that lenvatinib has clinical anticancer activity in patients with pretreated advanced HCC. Lenvatinib can be considered not only as the first line therapy for advanced HCC but also can be an effective and safe salvage therapy after sorafenib failure for advanced HCC.