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首页> 美国卫生研究院文献>Journal of Hepatocellular Carcinoma >A Comparison of Lenvatinib versus Sorafenib in the First-Line Treatment of Unresectable Hepatocellular Carcinoma: Selection Criteria to Guide Physician’s Choice in a New Therapeutic Scenario
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A Comparison of Lenvatinib versus Sorafenib in the First-Line Treatment of Unresectable Hepatocellular Carcinoma: Selection Criteria to Guide Physician’s Choice in a New Therapeutic Scenario

机译：Lenvatinib与索拉酮在不可切除的肝细胞癌第一线治疗中的比较：在新的治疗场景中指导医生选择的选择标准

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Hepatocellular carcinoma (HCC) is the fifth most common malignancy across the world. Alongside improvement in local approaches for early stages, the prognosis of patients with advanced disease remains poor. The tyrosine kinase inhibitor sorafenib was the first drug approved for advanced HCC. During the past decade, this has been extensively explored in real-life settings, such as Eastern Cooperative Oncology Group performance status 2, Child-Pugh B liver function, chronic kidney disease, HIV infection, transplant recipients and the elderly. After 10 years, the multikinase inhibitor lenvatinib was approved in first-line setting. The Phase III REFLECT trial established the non-inferiority of lenvatinib compared with sorafenib in terms of overall survival, meanwhile exploratory analysis suggests a potential benefit over sorafenib for patients with HBV chronic infection and positive alpha-fetoprotein value. Experience with lenvatinib for patients not matching the REFLECT trial criteria remains promising but still retrospective. Indeed, the treatment sequence after lenvatinib still remains a crucial issue, considering that standard second-line options were tested only in patients who progressed to sorafenib. Overall, the choice between lenvatinib and sorafenib should take into account key selection criteria from randomized trials, evidence to date in special clinical situations, the physician’s experience and patient’s preference. Fast approval of atezolizumab plus bevacizumab as first-line treatment for advanced HCC brought an additional element in this scenario. Undoubtedly, lenvatinib and sorafenib remain available options for patients who are not suitable or those progressed to combination immunotherapy. It is conceivable that new systemic options will contribute to design a new treatment algorithm for HCC in the near future. Meanwhile, prospective studies and biomarker analysis are needed to help physicians in the choice between lenvatinib and sorafenib.
机译：肝细胞癌（HCC）是世界上最常见的最常见的恶性肿瘤。随着局部早期阶段的改善，晚期疾病患者的预后仍然差。酪氨酸激酶抑制剂Sorafenib是第一种用于高级HCC的药物。在过去十年中，这在现实生活中已广泛探索，如东方合作肿瘤组性能状态2，儿童-PUGH B肝功能，慢性肾病，艾滋病毒感染，移植受者和老年人。 10年后，多立糖酶抑制剂Lenvatinib以一线设置批准。 III期反映试验确定了Lenvatinib的非自卑，与Sorafenib在整体存活方面，同时探索性分析表明HBV慢性感染和阳性α-胎蛋白值患者对索拉非尼潜在益处。 Lenvatinib对不匹配反映试验标准的患者的经验仍然有希望，但仍在回顾。实际上，考虑到在进展到索拉非尼的患者中，考虑到标准的第二线选项仍然是至关重要的问题，治疗序列仍然是至关重要的问题。总的来说，Lenvatinib和Sorafenib之间的选择应该考虑到随机试验的关键选择标准，在特殊的临床情况下迄今为止的证据，医生的经验和患者的偏好。快速批准Atezolizumab Plus Bevacizumab作为高级HCC的一线治疗，在这种情况下提出了额外的元素。毫无疑问，Lenvatinib和Sorafenib仍然适用于不适合的患者的可用选择，或者在组合免疫疗法方面的患者。可以想到，新的系统性选项将有助于在不久的将来设计一种新的HCC处理算法。同时，需要预期的研究和生物标志物分析来帮助医生在Lenvatinib和Sorafenib之间选择。

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