Lenvatinib With or Without Immune Checkpoint Inhibitors in Subsets of Advanced Hepatocellular Carcinoma

Objectives: Targeted agents combined with immune checkpoint inhibitors (ICIs) for advanced hepatocellular carcinoma (HCC) may improve survival for some patients. This study aims to identify the patients who are most likely to benefit from combination therapy. Methods: The study included 45 patients receiving lenvatinib while other 65 patients receiving lenvatinib plus ICIs between January 2019 and August 2020. Clinical and laboratory data were evaluated and compared. Results:The median follow-up was 20.5 months in the lenvatinib and 18.0 months in the combination group. The corresponding median overall survival was 9.3 and 13.0 months (p=0.004), respectively. Subgroup analyses found that lenvatinib plus ICIs was associated with better overall survival in patients younger than 60 years, males, without MAFLD as well as with BMI <23 kg/m(2), cirrhosis, HBV infection, total tumor volume >= 982 cm3, tumor burden score of >= 10.4 or alpha-fetoprotein >= 200 ng/ml. Conclusion: Lenvatinib plus ICIs therapy seems to be more effective in advanced HCC patients with viral etiology, low BMI, or high tumor load.

Automated summary

This study suggests that combination therapy of lenvatinib and immune checkpoint inhibitors may be more effective in improving the overall survival of advanced hepatocellular carcinoma patients with viral etiology, low BMI, or high tumor load.