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How Lenvatinib Compares With Other Therapies for Nonviral, Unresectable Liver Cancer

By: Amanda E. Ruffino, BA
Posted: Monday, March 13, 2023

Andrea Casadei-Gardini, MD, PhD, of IRCCS San Raffaele Scientific Institute Hospital, Milan, and colleagues retrospectively investigated the efficacy of an immunotherapy combination in comparison with kinase inhibitors in patients with nonviral hepatocellular carcinoma and evaluated potential differences in outcomes based on nonalcoholic fatty liver disease (NAFLD)/nonalcoholic steatohepatitis (NASH) status. Published in ESMO Open, the research used prospectively collected data from 969 patients with nonviral advanced hepatocellular carcinoma who were treated with atezolizumab plus bevacizumab, lenvatinib, or sorafenib. Of the 969 patients, 569 received lenvatinib, 210 received sorafenib, and 190 received atezolizumab plus bevacizumab. Represented in this analysis were 36 centers in 4 countries (Italy, Japan, Republic of Korea, and the United Kingdom).

The results showed that in the entire cohort, lenvatinib was associated with longer overall survival (hazard ratio [HR] = 0.65; P = .0268) and progression-free survival (HR = 0.67; P = .002) compared with atezolizumab plus bevacizumab. In the NAFLD/NASH patient population, lenvatinib treatment was associated with longer overall survival (HR = 0.46; P = .0110) and progression-free survival (HR = 0.55; P = .031) compared with atezolizumab plus bevacizumab, whereas there was no difference in outcomes between the two treatments in the non-NAFLD/NASH patient population. Propensity score matching analysis confirmed these findings. No significant difference in survival was observed between atezolizumab plus bevacizumab and sorafenib.

The findings suggest that patients with nonviral hepatocellular carcinoma, particularly those with NAFLD/NASH-related disease, may benefit more from lenvatinib treatment than immunotherapy. These results provide valuable insights for clinicians and researchers who are looking to optimize treatment options for patients with nonviral hepatocellular carcinoma. Nevertheless, further studies are needed to determine the factors contributing to the differences in treatment outcomes based on NAFLD/NASH status.

Disclosure: For full disclosures of the study authors, visit

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