Dr. Vogel on the Utility of Frontline Lenvatinib or Sorafenib in HCC

Arndt Vogel, MD, managing senior consultant, professor, Department of Gastroenterology, Hepatology and Endocrinology, head, GI-Cancer Center, Hannover Medical School, Hannover, Germany, discusses the utility of frontline lenvatinib (Lenvima) or sorafenib (Nexavar) in hepatocellular carcinoma (HCC).

Although the combination of atezolizumab (Tecentriq) and bevacizumab (Avastin) remains the standard frontline therapy for patients with HCC, immunotherapy-based treatment is not indicated for a small proportion of patients, Vogel says. In this population, single-agent TKIs, such as lenvatinib or sorafenib, are preferred.

Treatment selection between lenvatinib and sorafenib is dependent on the patient’s individual clinical and tumor characteristics, Vogel explains. Although robust biomarkers are not available in HCC, identification of FGF19 amplifications, which are present in approximately 5% of patients, could inform clinical decisions. Additionally, the safety profiles of the agents, although similar, should be considered, Vogel adds.

Notably, the higher response rate observed with frontline lenvatinib vs sorafenib in patients with unresectable HCC is a driving component of why lenvatinib is being used more frequently in clinical practice. However, more data for patients with more advanced HCC, such as those with Child-Pugh B disease, are available with sorafenib, which should be considered when selecting between the agents, Vogel concludes.

Dr. Vogel was interviewed by OncLive® during the ILCA 2021 Annual Conference.