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Adverse Events Inform Treatment Decisions in HCC for Frontline Lenvatinib Versus Sorafenib

David J. Pinato, MD, PhD
Published Online:1:24 PM, Wed September 25, 2019


David J. Pinato, MD, PhD, clinical senior lecturer in medical oncology, clinician scientist, and consultant medical oncologist, Department of Surgery and Cancer, Imperial College London, discusses the approach to selecting the appropriate frontline agent for patients with hepatocellular carcinoma (HCC). Sorafenib (Nexavar) has been around for many years, but now that lenvatinib (Lenvima) is FDA approved as well, physicians can now choose between the 2 agents.

The phase III REFLECT trial demonstrated that lenvatinib is noninferior to sorafenib in treating patients with HCC. Pinato notes that this is especially noted in patients with less than 50% occupancy of liver deposits and those without main portal vein thrombosis. In countries where both lenvatinib and sorafenib are options for the frontline treatment of HCC, drug selection relies on the toxicity profile rather than biomarkers of efficacy, as in other cancer types.

Although lenvatinib is characterized by a higher proportion of adverse events relating to hypertension and proteinuria, Pinato says the community feels the toxicity profile is the most important factor to informing treatment decisions. The lack of biomarkers in this space has been an interesting limitation to drug development, says Pinato, unlike many other cancer types where drugs are sorted by biomarkers.
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