Li Xiaomi, Wang Jingyan, Ding Xiaoyan, Xu Yawen, Yu Minghua, Wu Hongxiao, Deng Na, Li Wei, Chen Jinglong
Department of Cancer Center, Beijing Ditan Hospital, Capital Medical University, Beijing, China.
Department of Interventional Radiology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, China.
Front Pharmacol. 2023 Jan 10;13:1032881. doi: 10.3389/fphar.2022.1032881. eCollection 2022.
Lenvatinib is recommended as a first-line tyrosine kinase inhibitor for advanced hepatocellular carcinoma (HCC) since 2017. The aim of this study was to compare the clinical action of lenvatinib in hepatitis B virus (HBV)-related HCC and hepatitis C virus (HCV)-related HCC. A continuous cohort of advanced HCC was retrospectively enrolled. And the patients were divided into HBV-related HCC and HCV-related HCC based on previous history of hepatitis virus infection. Then propensity score matching (PSM) was conducted to compare objective response rate (ORR),disease control rate (DCR),progression-free survival (PFS),overall survival (OS) and safety between the two groups. A total of 203 eligible patients were included, with 72 HBV-related HCC and 36 HCV-related HCC after PSM. Both ORR (20.8% vs. 5.6%, P = .0759) and DCR (76.4% vs. 52.8%, P = .0232) were significantly higher in the HBV-related HCC than in the HCV-related HCC. Although no statistical differences in PFS (6.1 months vs. 3.3 months, P = .17) and OS (14.9 months vs. 17.7 months, P = .96) were observed between the two groups, there was a trend of difference in the PFS survival curve. On multivariate regression analysis of PFS, both HBV infection (HR, .54; 95% CI, .31-.95; P = .0332) and antiviral time >5 years (HR, .49; 95% CI, .26-.9; P = .0219) were identified as independent favorable factors, and AFP >200 ng/mL (HR, 1.88; 95% CI, 1.1-3.22; P = .0216) were found to be an independent adverse factor. In addition, compared with HCC who received the first dose of antiviral drugs less than 5 years, the patients who were administered those drugs over 5 years had a significantly favorable PFS (11.27 months vs. 3.87 months, P = .0011). Lenvatinib was well tolerated in all patients and the adverse events (AEs) were similar between the two groups. It seemed that lenvatinib benefited more in HBV-related advanced HCC in delaying disease progression, compared to those with HCV-related advanced HCC.
自2017年以来，乐伐替尼被推荐作为晚期肝细胞癌（HCC）的一线酪氨酸激酶抑制剂。本研究的目的是比较乐伐替尼在乙型肝炎病毒（HBV）相关HCC和丙型肝炎病毒（HCV）相关HCC中的临床作用。回顾性纳入了一组连续的晚期HCC患者。根据既往肝炎病毒感染史将患者分为HBV相关HCC和HCV相关HCC。然后进行倾向评分匹配（PSM），以比较两组之间的客观缓解率（ORR）、疾病控制率（DCR）、无进展生存期（PFS）、总生存期（OS）和安全性。共纳入203例符合条件的患者，PSM后，HBV相关HCC患者72例，HCV相关HCC患者36例。HBV相关HCC的ORR（20.8%对5.6%，P = 0.0759）和DCR（76.4%对52.8%，P = 0.0232）均显著高于HCV相关HCC。虽然两组之间在PFS（6.1个月对3.3个月，P = 0.17）和OS（14.9个月对17.7个月，P = 0.96）方面未观察到统计学差异，但PFS生存曲线存在差异趋势。在PFS的多因素回归分析中，HBV感染（HR，0.54；95%CI，0.31 - 0.95；P = 0.0332）和抗病毒时间>5年（HR，0.49；95%CI，0.26 - 0.9；P = 0.0219）均被确定为独立的有利因素，而甲胎蛋白（AFP）>200 ng/mL（HR，1.88；95%CI，1.1 - 3.22；P = 0.0216）被发现是一个独立的不利因素。此外，与接受抗病毒药物首剂治疗时间小于5年的HCC患者相比，接受抗病毒药物治疗超过5年的患者的PFS明显更有利（11.27个月对3.87个月，P = 0.0011）。所有患者对乐伐替尼耐受性良好，两组之间的不良事件（AE）相似。与HCV相关晚期HCC相比，乐伐替尼似乎在延缓疾病进展方面使HBV相关晚期HCC获益更多。
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