{"entity":{"id":"paper-reflect-lenvatinib-lancet-2018","kind":"paper","name":"REFLECT: lenvatinib versus sorafenib in first-line treatment of unresectable hepatocellular carcinoma","aka":[],"tldr":"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.\n\nMedian 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.","asOf":"2026-09-17","links":[{"label":"Lancet 2018","url":"https://doi.org/10.1016/S0140-6736(18)30207-1"},{"label":"PubMed","url":"https://pubmed.ncbi.nlm.nih.gov/29433850/"}],"tags":[],"related":[],"cancers":["hcc-advanced"],"sections":[],"technologies":[],"targets":[],"drugs":["lenvatinib","sorafenib"],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":["reflect"],"people":[],"bottlenecks":[],"keyPapers":[],"journals":["lancet"],"dependsOn":[],"notes":[],"journal":"The Lancet","year":2018,"doi":"10.1016/S0140-6736(18)30207-1","pmid":"29433850","authors":"Kudo M, Finn RS, Qin S, et al.","paperType":"rct","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."],"whatItMeans":"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."],"changedPractice":true,"participants":954},"route":"/key-papers/paper-reflect-lenvatinib-lancet-2018/","neighbours":{"cancer":[{"id":"hcc-advanced","kind":"cancer","name":"Advanced hepatocellular carcinoma (BCLC C)","route":"/cancers/hcc-advanced/"}],"drug":[{"id":"lenvatinib","kind":"drug","name":"Lenvatinib","route":"/drugs/lenvatinib/"},{"id":"sorafenib","kind":"drug","name":"Sorafenib","route":"/drugs/sorafenib/"}],"trial":[{"id":"reflect","kind":"trial","name":"REFLECT","route":"/trials/reflect/"}],"journal":[{"id":"lancet","kind":"journal","name":"The Lancet","route":"/journals/lancet/"}]}}