Department of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China.
State Key Laboratory of Translational Oncology, Sir YK Pao Centre for Cancer, Hong Kong Cancer Institute, The Chinese University of Hong Kong, Hong Kong SAR, China.
Clin Mol Hepatol. 2023 Oct;29(4):909-923. doi: 10.3350/cmh.2023.0114. Epub 2023 May 25.
Emergence of multi-targeted kinase inhibitors (MTIs) and immune checkpoint inhibitors (ICI) have changed the landscape of management in hepatocellular carcinoma (HCC). Combination therapy involving ICI has superseded sorafenib as the first-line treatment option for advanced HCC due to their superior response rates and survival benefits based on recently published phase III trials. However, the role of first-line lenvatinib remains uncertain as no prospective trials have compared its efficacy with ICI in advanced HCC. Several retrospective studies have shown that first-line lenvatinib may not be inferior to ICI combination. Indeed, a growing body of evidence suggests that ICI treatment is associated with inferior treatment outcome in non-viral HCC patients, questioning the supremacy of ICI treatment in all patients and rendering first-line lenvatinib as a potential preferred treatment option. Furthermore, in high-burden intermediate-stage HCC, accumulating evidence supports first-line lenvatinib, or in combination with transarterial chemoembolization (TACE), as a preferred treatment option over TACE alone. In this Review, we describe the latest evidence surrounding the evolving role of first-line lenvatinib in HCC.
多靶点激酶抑制剂 (MTKIs) 和免疫检查点抑制剂 (ICI) 的出现改变了肝细胞癌 (HCC) 的治疗格局。基于最近发表的 III 期试验，ICI 联合治疗因其更高的缓解率和生存获益，已取代索拉非尼成为晚期 HCC 的一线治疗选择。然而，一线仑伐替尼的作用仍不确定，因为尚无前瞻性试验比较其在晚期 HCC 中的疗效与 ICI。几项回顾性研究表明，一线仑伐替尼可能并不逊于 ICI 联合治疗。事实上，越来越多的证据表明，ICI 治疗与非病毒性 HCC 患者的治疗结局较差相关，这对所有患者中 ICI 治疗的优越性提出了质疑，并使一线仑伐替尼成为一种潜在的首选治疗选择。此外，在高负担的中期 HCC 中，越来越多的证据支持一线仑伐替尼或联合经动脉化疗栓塞 (TACE) 作为首选治疗方案，优于单独 TACE。在这篇综述中，我们描述了一线仑伐替尼在 HCC 中不断演变的作用的最新证据。
