Chen Yen-Yang, Wang Chih-Chi, Liu Yueh-Wei, Li Wei-Feng, Chen Yen-Hao
Department of Hematology-Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Division of General Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
PeerJ. 2020 Nov 13;8:e10382. doi: 10.7717/peerj.10382. eCollection 2020.
Lenvatinib has been approved for use in the systemic treatment for unresectable hepatocellular carcinoma (HCC). This study aimed to investigate the efficacy and safety of lenvatinib in patients with unresectable HCC who received sorafenib.
A total of 40 patients who received lenvatinib after sorafenib were retrospectively identified: as second line in 20 patients, third line in 10 patients, and fourth line and later lines in 10 patients. The treatment response to lenvatinib was determined in accordance with the guidelines of the modified Response Evaluation Criteria in Solid Tumors (mRECIST) every 2-3 months after commencement of lenvatinib.
Median progression-free survival (PFS) and median overall survival (OS) of the whole population were 3.3 and 9.8 months, respectively. The objective response rate was 27.5%. Univariate and multivariate analyses showed that alpha-fetoprotein level >400 ng/mL was an independent prognostic factor of worse PFS and OS. The clinical outcomes of lenvatinib therapy as second-line, third-line, or fourth line and later line treatment were similar, and previous response to sorafenib could predict the response to subsequent lenvatinib. Most adverse events were grades 1-2, and the majority of patients tolerated the side effects. Our study confirms the efficacy and safety of lenvatinib as second-line and later line treatment for patients with unresectable HCC who received sorafenib in clinical practice.
乐伐替尼已被批准用于不可切除肝细胞癌（HCC）的全身治疗。本研究旨在探讨乐伐替尼在接受过索拉非尼治疗的不可切除HCC患者中的疗效和安全性。
回顾性纳入40例在索拉非尼治疗后接受乐伐替尼治疗的患者：20例为二线治疗，10例为三线治疗，10例为四线及更后线治疗。在乐伐替尼开始治疗后每2 - 3个月，根据改良实体瘤疗效评价标准（mRECIST）指南确定对乐伐替尼的治疗反应。
总体人群的中位无进展生存期（PFS）和中位总生存期（OS）分别为3.3个月和9.8个月。客观缓解率为27.5%。单因素和多因素分析显示，甲胎蛋白水平>400 ng/mL是PFS和OS较差的独立预后因素。乐伐替尼作为二线、三线或四线及更后线治疗的临床结局相似，既往对索拉非尼的反应可预测对后续乐伐替尼的反应。大多数不良事件为1 - 2级，大多数患者耐受这些副作用。我们的研究证实了乐伐替尼作为二线及更后线治疗在临床实践中对接受过索拉非尼治疗的不可切除HCC患者的疗效和安全性。
