Five years of lenvatinib in hepatocellular carcinoma: are there any predictive and/or prognostic factors?

ABSTRACT

Introduction

Lenvatinib was the first drug approved in 2017 for first-line treatment of hepatocarcinoma (HCC) after 10 years of Sorafenib as exclusive standard of care. The therapeutic armamentarium has recently expanded following the approval of atezolizumab plus bevacizumab.

Areas covered

Numerous studies have been conducted during the past 5 years on Lenvatinib use in real-world settings in an effort to determine prognostic and predictive factors of Lenvatinib efficacy. In order to choose the most effective therapeutic approach, it may be helpful to summarize these results in this review.

Expert opinion

A subgroup that appears to benefit most from Lenvatinib therapy are patients with non-viral cirrhosis. This aspect is of great importance today considering the increase in NASH prevalence. Also, a significant proportion of BCLC B patients appear to respond well to Lenvatinib therapy. The biological heterogeneity highlighted in HCC patients, along with the growing number of therapeutic options, makes the identification of stratification tools able to define which patients are more likely to respond to a treatment rather than another one of crucial interest. Further investigation deepening the biological pathways underlying HCC carcinogenesis are of particular interest in order to pave the way for precision medicine even for HCC patients.

KEYWORDS:

• Lenvatinib
• hepatocellular carcinoma
• predictive factors
• prognostic factors
• tyrosine kinase inhibitor
• adverse events
• HCC etiology
• BCLC stage
• dose intensity

Article highlights

• Lenvatinib was the first drug approved in 2017 for first-line treatment of hepatocarcinoma after 10 years of Sorafenib as exclusive standard of care in this setting.

• Finding prognostic and predictive indicators that can identify patients who will respond better to one treatment over another is crucial to help clinicians in clinical practice decision-making.

• Patients with BCLC-B stage and high tumor burden (beyond the up-to-seven criteria) appear to respond very well to Lenvatinib therapy.

• Lenvatinib has been shown to obtain better outcomes in patients with preserved liver function (CP A and ALBI 1) and with low baseline αFP levels.

• A subgroup that appears to benefit most from Lenvatinib therapy is represented by patients with non-viral etiology.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

The authors have no funding to report.