Sato Rui, Moriguchi Michihisa, Iwai Kenji, Tsuchiya Satoshi, Seko Yuya, Takahashi Aya, Kobayashi Kazufumi, Ogasawara Sadahisa, Watanabe Shunji, Morimoto Naoki, Kato Naoya, Itoh Yoshito, Aramaki Takeshi
Division of Interventional Radiology, Shizuoka Cancer Center, Sunto-Gun, Japan.
Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Hepatol Res. 2022 Oct;52(10):859-871. doi: 10.1111/hepr.13818. Epub 2022 Aug 17.
There is insufficient evidence regarding the safety and efficacy of molecular targeted agents (MTAs) for elderly patients with hepatocellular carcinoma (HCC), who are likely to be vulnerable to adverse events (AEs) of therapy. The aim of this study was to compare sorafenib and lenvatinib use in elderly patients with HCC from the viewpoint of overall survival (OS) and rate of AE-induced MTA discontinuation.
This retrospective study included patients with HCC over 80 years old who received first-line molecular targeted therapy (MTT) at four hospitals between June 2009 and September 2019. They were divided into three groups according to the era and type of first-line MTA: E1-Sora (sorafenib, between 2009 and 2016), E2-Sora (sorafenib, between 2017 and 2019), and E2-Len (lenvatinib, between 2017 and 2019).
The study included 173 patients (E1-Sora, n = 79; E2-Sora, n = 50; E2-Len, n = 44) with a median age of 81.9 years (range, 80-93 years). Median OS was 15.1 months in the entire cohort (E1-Sora, 12.7 months; E2-Sora, 20.5 months; E2-Len, 10.3 months). The rate of treatment discontinuation due to AEs was high in the entire cohort, especially in E1-Sora and E2-Len (49.4% in E1-Sora, 28.0% in E2-Sora, and 54.6% in E2-Len, p = 0.0753). More E2-Sora patients received subsequent MTT than E2-Len patients (E2-Sora, 50%; E2-Len, 28.6%; p = 0.0111).
Both sorafenib and lenvatinib were effective and feasible for elderly patients with HCC. In terms of discontinuation due to AEs and subsequent MTT, sorafenib might be more desirable for elderly patients with HCC over 80 years.
关于分子靶向药物（MTAs）用于老年肝细胞癌（HCC）患者的安全性和有效性，证据尚不充分，而这类患者可能对治疗的不良事件（AEs）较为敏感。本研究的目的是从总生存期（OS）和AE导致的MTAs停药率的角度，比较索拉非尼和仑伐替尼在老年HCC患者中的应用情况。
这项回顾性研究纳入了2009年6月至2019年9月期间在四家医院接受一线分子靶向治疗（MTT）的80岁以上HCC患者。根据一线MTA的时代和类型，将他们分为三组：E1-索拉（索拉非尼，2009年至2016年）、E2-索拉（索拉非尼，2017年至2019年）和E2-仑（仑伐替尼，2017年至2019年）。
该研究纳入了173例患者（E1-索拉组，n = 79；E2-索拉组，n = 50；E2-仑组，n = 44），中位年龄为81.9岁（范围80 - 93岁）。整个队列的中位OS为15.1个月（E1-索拉组，12.7个月；E2-索拉组，20.5个月；E2-仑组，10.3个月）。整个队列中因AE导致的治疗停药率较高，尤其是在E1-索拉组和E2-仑组（E1-索拉组为49.4%，E2-索拉组为28.0%，E2-仑组为54.6%，p = 0.0753）。接受后续MTT的E2-索拉组患者比E2-仑组患者更多（E2-索拉组为50%；E2-仑组为28.6%；p = 0.0111）。
索拉非尼和仑伐替尼对老年HCC患者均有效且可行。就因AE停药和后续MTT而言，对于80岁以上的老年HCC患者，索拉非尼可能更合适。
