REFLECT: lenvatinib versus sorafenib in first-line treatment of unresectable hepatocellular carcinoma
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.
Overview
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.
- Median overall survival 13.6 vs 12.3 months; hazard ratio 0.92 (non-inferior).
- Objective response 24.1 percent vs 9.2 percent.
Lenvatinib is a first-line alternative to sorafenib and the preferred kinase inhibitor when immunotherapy is contraindicated, such as after liver transplantation.
- Excluded main portal vein invasion and over 50 percent liver involvement.
- Non-inferiority rather than superiority.
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