Comparing Sorafenib and Lenvatinib for the Frontline Treatment of Advanced HCC

Richard S. Finn, MD, professor of Clinical Medicine Division of Hematology/ Oncology UCLA David Geffen School of Medicine University of California, Los Angeles, discusses the considerations he makes when selecting frontline treatment for patients with advanced hepatocellular carcinoma (HCC).

Both sorafenib (Nexavar) and lenvatinib (Lenvima) have been approved by the FDA for the treatment of patients with advanced HCC in the frontline setting. The overall survival difference, according to the REFLECT trial, was a noninferiority endpoint, so Finn says neither agent is superior over the other.

According to both traditional and modified RECIST criteria, lenvatinib has a higher response rate, but no drug has ever been able to beat the survival rates seen with sorafenib, Finn notes. Data from the REFLECT study showed that if a patient has a response with either agent, that could provide a survival of 22 months, or even more in select patient populations.

For patients that are fit with child pugh A, lenvatinib is a very good option, as well as sorafenib. However, for patients that are not as well compensated and given the safety experience with sorafenib, Finn says he would lean more toward using sorafenib over lenvatinib. Additionally, he adds that for bulky tumors or high AFP, or any other poor prognostic factors, he is more likely to give lenvatinib due to the need for a response.

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