Liver Cancer (Mar 2022)

Lenvatinib with or without concurrent drug-eluting beads transarterial chemoembolization in patients with unresectable, advanced hepatocellular carcinoma: A real-world, multicenter, retrospective study

  • Dongdong Xia,
  • Wei Bai,
  • Enxin Wang,
  • Jiaping Li,
  • Xiaoming Chen,
  • Zhexuan Wang,
  • Mingsheng Huang,
  • Ming Huang,
  • Junhui Sun,
  • Weizhu Yang,
  • Zhengyu Lin,
  • Jianbing Wu,
  • Zixiang Li,
  • Shufa Yang,
  • Xu Zhu,
  • Zaizhong Chen,
  • Yanfang Zhang,
  • Wenzhe Fan,
  • Qicong Mai,
  • Rong Ding,
  • Chunhui Nie,
  • Long Feng,
  • Xueda Li,
  • Wukui Huang,
  • Jun Sun,
  • Qiuhe Wang,
  • Yong Lv,
  • Xiaomei Li,
  • Bohan Luo,
  • Zhengyu Wang,
  • Jie Yuan,
  • Wengang Guo,
  • Kai Li,
  • Bing Li,
  • Ruijun Li,
  • Zhanxin Yin,
  • Jielai Xia,
  • Guohong Han

DOI
https://doi.org/10.1159/000523849

Abstract

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Introduction: Lenvatinib is the first-line treatment for advanced hepatocellular carcinoma (HCC). We aimed to compare the clinical outcomes of lenvatinib plus drug-eluting beads transarterial chemoembolization (DEB-TACE) versus lenvatinib alone in real-world practice. Methods: This retrospective analysis included 142 consecutive patients who received lenvatinib plus DEB-TACE and 69 patients who received lenvatinib alone as first-line treatment from 15 Chinese academic centers from Nov 2018 to Nov 2019. Overall survival (OS), progression-free survival (PFS), objective response rate (ORR) evaluated by mRECIST criteria, and safety profiles were compared between the two groups. Results: The median OS and PFS were significantly longer in the combined therapy group than in the monotherapy group in whole cohort (median OS, 15.9 vs 8.6 months, p=0.0022; median PFS, 8.6 vs 4.4 months, p<0.001) and after propensity score matching analysis (median OS, 13.8 vs 7.8 months, p=0.03; median PFS, 7.8 vs 4.5 months, p=0.009). Moreover, the treatment option was an independent prognostic factor for OS and PFS with adjustment based upon baseline characteristics (adjusted hazard ratio [HR]=0.53, 95% confidence interval [CI]: 0.36–0.78, p=0.001, and adjusted HR=0.42, 95% CI: 0.30–0.60, p<0.001, respectively) and propensity score (adjusted HR=0.52, 95% CI: 0.36–0.76, p=0.001, and adjusted HR=0.46, 95% CI: 0.33-0.64, p<0.001, respectively). Moreover, a greater ORR was observed in the combined group (ORR=46.48% vs. 13.05%, p<0.001). Furthermore, the most common adverse events were elevated AST (54.9%) and fatigue (46.4%) in the lenvatinib plus DEB-TACE group and lenvatinib group, respectively. Most adverse events were mild-to-moderate and manageable. Conclusions: With well-tolerated safety, lenvatinib plus DEB-TACE was more effective than lenvatinib monotherapy in improving OS, PFS, and ORR. Thus, it may be a promising treatment for advanced HCC. Future prospective studies confirming these findings are warranted.