A recent study published in Nature has shed light on the comparative effectiveness of transcatheter arterial chemoembolization (TACE) combined with either Sorafenib (TACE-S) or Lenvatinib (TACE-L) in patients with intermediate-stage hepatocellular carcinoma (HCC). The retrospective analysis suggests that TACE-S leads to better overall survival (OS) than TACE-L in this patient population, although no significant difference was observed in progression-free survival (PFS).
The research, which examined outcomes in patients with Barcelona Clinic Liver Cancer (BCLC) stage B HCC, highlights a potential advantage for Sorafenib in the context of TACE therapy. While previous studies have shown Lenvatinib to be non-inferior to Sorafenib in advanced HCC, this study suggests a nuanced difference in intermediate stages, particularly concerning OS.
Key Findings
The study revealed that the superior OS observed with TACE-S might be related to the high prevalence of portal hypertension among the enrolled patients. According to the paper, 65% of intermediate HCC patients in this study had portal hypertension. Sorafenib has been shown to attenuate portal circulation by reducing neovascularization and improving hemodynamics, while Lenvatinib may aggravate portal hypertension by targeting fibroblast growth factor receptors (FGFR).
"In the process of clinical treatment, cTACE combined with Lenvatinib should be used judiciously," the authors stated. "Oncologist should investigate the patient’s portal hypertension circumstance and formulated the regiment carefully."
Study Details and Limitations
The retrospective study design introduces potential selection, recall, and missing biases. The researchers acknowledge that the relatively small patient numbers in each group may limit the generalizability of the results. Future randomized controlled trials (RCTs) with larger sample sizes are warranted to validate these findings and explore the underlying molecular pathways.
Furthermore, the study notes that post-progression therapies, such as Atezolizumab plus bevacizumab or radiofrequency ablation, were common switching treatments in both groups, which could influence survival outcomes. The study also found a significantly higher proportion of tumors with a maximum diameter ≥ 10 cm in the TACE-L group (21.3% vs. 5.4%, p = 0.012), which could influence survival outcomes.
Implications for Clinical Practice
Despite the limitations, this study provides valuable insights into the treatment of intermediate-stage HCC. The findings suggest that TACE-S may be a more effective strategy than TACE-L in patients with portal hypertension. Clinicians should carefully evaluate patients for portal hypertension before deciding on a TACE regimen and consider the potential benefits of Sorafenib in this specific subgroup.
