# REFLECT: lenvatinib versus sorafenib in first-line treatment of unresectable hepatocellular carcinoma

Source: https://onco.cc/key-papers/paper-reflect-lenvatinib-lancet-2018/  
OnCo record `paper-reflect-lenvatinib-lancet-2018` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Lenvatinib matched sorafenib for survival in advanced liver cancer while shrinking tumours far more often and delaying progression longer, making it the first new first-line option in ten years.

## Summary

Phase 3 non-inferiority trial of 954 patients with unresectable hepatocellular carcinoma randomised to lenvatinib (weight-based 8 or 12 mg) or sorafenib.

Median overall survival was 13.6 versus 12.3 months (hazard ratio 0.92, non-inferior), progression-free survival 7.4 versus 3.7 months, and response 24.1 versus 9.2 percent; hypertension, proteinuria and decreased appetite were more frequent with lenvatinib.

## Fields

- Kind: Key paper
- Last checked: 2026-09-17
- Journal: The Lancet
- Year: 2018
- DOI: 10.1016/S0140-6736(18)30207-1
- Authors: Kudo M, Finn RS, Qin S, et al.
- Findings: Median overall survival 13.6 vs 12.3 months; hazard ratio 0.92 (non-inferior).; Objective response 24.1 percent vs 9.2 percent.
- What it means: Lenvatinib is a first-line alternative to sorafenib and the preferred kinase inhibitor when immunotherapy is contraindicated, such as after liver transplantation.
- Caveats: Excluded main portal vein invasion and over 50 percent liver involvement.; Non-inferiority rather than superiority.

## Sources

- Lancet 2018: https://doi.org/10.1016/S0140-6736(18)30207-1
- PubMed: https://pubmed.ncbi.nlm.nih.gov/29433850/

## Connected records

- cancers: [Advanced hepatocellular carcinoma (BCLC C)](https://onco.cc/cancers/hcc-advanced/)
- drugs: [Lenvatinib](https://onco.cc/drugs/lenvatinib/), [Sorafenib](https://onco.cc/drugs/sorafenib/)
- trials: [REFLECT](https://onco.cc/trials/reflect/)
- journals: [The Lancet](https://onco.cc/journals/lancet/)

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