Real-world efficacy and prognostic factors of lenvatinib plus PD-1 inhibitors in 378 unresectable hepatocellular carcinoma patients

Xu Yang, Bowen Chen, Yanyu Wang, Yunchao Wang, Junyu Long, Nan Zhang, Jingnan Xue, Ziyu Xun, Linzhi Zhang, Jiamin Cheng, Jin Lei, Huishan Sun, Yiran Li, Jianzhen Lin, Fucun Xie, Dongxu Wang, Jie Pan, Ke Hu, Mei Guan, Li Huo, Jie Shi, Lingxiang Yu, Lin Zhou, Jinxue Zhou, Zhenhui Lu, Xiaobo Yang, Yilei Mao, Xinting Sang, Yinying Lu, Haitao Zhao, Xu Yang, Bowen Chen, Yanyu Wang, Yunchao Wang, Junyu Long, Nan Zhang, Jingnan Xue, Ziyu Xun, Linzhi Zhang, Jiamin Cheng, Jin Lei, Huishan Sun, Yiran Li, Jianzhen Lin, Fucun Xie, Dongxu Wang, Jie Pan, Ke Hu, Mei Guan, Li Huo, Jie Shi, Lingxiang Yu, Lin Zhou, Jinxue Zhou, Zhenhui Lu, Xiaobo Yang, Yilei Mao, Xinting Sang, Yinying Lu, Haitao Zhao

Abstract

Introduction: Combining lenvatinib with a programmed cell death protein-1 (PD-1) inhibitor has been explored for the treatment of un-resectable hepatocellular carcinoma (uHCC). This study aimed to investigate the real-world efficacy of and prognostic factors for survival associated with lenvatinib plus PD-1 inhibitor treatment in a large cohort of Asian uHCC patients even the global LEAP-002 study failed to achieve the primary endpoints.

Methods: Patients with uHCC treated with lenvatinib and PD-1 inhibitors were included. The primary endpoints were overall survival (OS) and progression-free survival (PFS), and the secondary endpoints were the objective response rate (ORR) and adverse events (AEs). Prognostic factors for survival were also analyzed.

Results: A total of 378 uHCC patients from two medical centers in China were assessed retrospectively. The median patient age was 55 years, and 86.5% of patients were male. Hepatitis B virus (HBV) infection (89.9%) was the dominant etiology of uHCC. The median OS was 17.8 (95% confidence interval (CI) 14.0-21.6) months. The median PFS was 6.9 (95% CI 6.0-7.9) months. The best ORR and disease control rate (DCR) were 19.6% and 73.5%, respectively. In multivariate analysis, Child‒Pugh grade, Barcelona Clinic Liver Cancer stage, Eastern Cooperative Oncology Group performance status score, involved organs, tumor burden score, and combination with local therapy were independent prognostic factors for OS. A total of 100% and 57.9% of patients experienced all-grade and grade 3/4 treatment-emergent AEs, respectively.

Conclusion: This real-world study of lenvatinib plus PD-1 inhibitor treatment demonstrated long survival and considerable ORRs and DCRs in uHCC patients in China. The tolerability of combination therapy was acceptable but must be monitored closely.

Keywords: Adverse events; Hepatitis B virus; Hepatocellular carcinoma; Lenvatinib; Nivolumab; PD-1 inhibitor; Pembrolizumab; Un-resectable.

Conflict of interest statement

Xu Yang, Bowen Chen, Yanyu Wang, Yunchao Wang, Junyu Long, Nan Zhang, Jingnan Xue, Ziyu Xun, Linzhi Zhang, Jiamin Cheng, Jin Lei, Huishan Sun, Yiran Li, Jianzhen Lin, Fucun Xie, Dongxu Wang, Jie Pan, Ke Hu, Mei Guan, Li Huo, Jie Shi, Lingxiang Yu, Lin Zhou, Jinxue Zhou, Zhenhui Lu, Xiaobo Yang, Yilei Mao, Xinting Sang, Yinying Lu, Haitao Zhao declare no conflict of interest.

© 2023. The Author(s).

Figures

Fig. 1
Fig. 1
Flowchart of the study design
Fig. 2
Fig. 2
Kaplan‒Meier estimates of overall survival (A) and progression-free survival (B)
Fig. 3
Fig. 3
Kaplan‒Meier curves for overall survival stratified by Child‒Pugh classification (A), Eastern Cooperative Oncology Group (ECOG) performance status (PS) score (B), involved organs (C), tumor burden score (D), Barcelona Clinic Liver Cancer (BCLC) stage (E), and combination with local therapy (F) subgroups

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