A change in the timing for starting systemic therapies for hepatocellular carcinoma : the comparison of sorafenib and lenvatinib as the first-line treatment

Aim : The aim of this retrospective multicenter study was to evaluate the differences in the timing for starting systemic therapies as the first-line treatment for hepatocellular carcinoma (HCC). Methods : A total of 375 patients with HCC treated with sorafenib from May 2009 to March 2018 and 56 patients treated with lenvatinib from March 2018 to November 2018 at our affiliated hospitals were included in this study. Results : The median ages of the sorafenib and lenvatinib groups were 71.0 (interquartile range [IQR] : 64.0-77.0) and 73.5 (IQR : 68.0 -80.0) years old, and 300 (80.0%) and 42 (75.0%) patients were men, respectively. The Barcelona Clinic Liver Cancer stage was early, intermediate and advanced in 39 patients (10.4%), 133 patients (35.5%) and 203 patients (54.1%) in the sorafenib group and 1 patient (1.8%), 17 patients (30.4%) and 38 patients (67.9%)in the lenvatinib group, respectively. In the analysis of intermediate HCC, patients who satisfied the criteria of TACE failure/refractoriness(P=0.017), those with ALBI grade 1 (P=0.040), and those with a serum AFP level <200 ng/ml (P=0.027)were found more frequently in the lenvatinib group than in the sorafenib group, with statistical significance. The objective response rate (ORR) of lenvatinib was 34.8% in the overall patients and 46.7%in the intermediate-stage HCC patients, which was significantly higher than sorafenib (P=0.001, P=0.017). Conclusions : The emergence of lenvatinib has encouraged physicians to start systemic chemotherapy earlier in intermediate-stage HCC patients.