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Welland S, Leyh C, Finkelmeier F, Jefremow A, Shmanko K, Gonzalez-Carmona MA, Kandulski A, Jeliazkova P, Best J, Fründt TW, Djanani A, Pangerl M, Maieron A, Greil R, Fricke C, Sookthai D, Günther R, Schmiderer A, Wege H, Venerito M, Ehmer U, Müller M, Strassburg CP, Weinmann A, Siebler J, Waidmann O, Lange CM, Saborowski A, Vogel A. Real-World Data for Lenvatinib in Hepatocellular Carcinoma (ELEVATOR): A Retrospective Multicenter Study. Liver Cancer 2022; 11:219-232. [PMID: 35949288 PMCID: PMC9218621 DOI: 10.1159/000521746] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 12/31/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Lenvatinib is approved as first-line treatment for patients with advanced hepatocellular carcinoma (HCC). The efficacy of lenvatinib in Caucasian real-world patients is insufficiently defined. The purpose of this study was to evaluate the efficacy of lenvatinib in a multi-center cohort (ELEVATOR) from Germany and Austria. METHODS A retrospective data analysis of 205 patients treated with first-line systemic lenvatinib at 14 different sites was conducted. Overall survival, progression free survival, overall response rate and adverse event rates were assessed and analyzed. RESULTS Patients receiving lenvatinib in the real-world setting reached a median overall survival of 12.8 months, which was comparable to the results reported from the REFLECT study. Median overall survival (mOS) and progression free survival (mPFS) was superior in those patients who met the inclusion criteria of the REFLECT study compared to patients who failed to meet the inclusion criteria (mOS 15.6 vs 10.2 months, HR 0.55, 95% CI 0.38-0.81, p=0.002; mPFS 8.1 vs 4.8 months HR 0.65, 95% CI 0.46-0.91, p=0.0015). For patients with an impaired liver function according to the Albumin-Bilirubin (ALBI) grade, or reduced ECOG performance status ≥2, survival was significantly shorter compared to patients with sustained liver function (ALBI grade 1) and good performance status (ECOG performance status 0), respectively (HR 1.69, 95% CI 1.07-2.66, p=0.023; HR 2.25, 95% CI 1.19-4.23, p=0.012). Additionally, macrovascular invasion (HR 1.55, 95% CI 1.02-2.37, p=0.041) and an AFP ≥200 ng/mL (HR 1.56, 95% CI 1.03-2.34, p=0.034) were confirmed as independent negative prognostic factors in our cohort of patients with advanced HCC. CONCLUSION Overall, our data confirm the efficacy of lenvatinib as first-line treatment and did not reveal new or unexpected side effects in a large retrospective Caucasian real-world cohort, supporting the use of lenvatinib as meaningful alternative for patients that cannot be treated with IO-based combinations in first-line HCC.
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Affiliation(s)
- Sabrina Welland
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Catherine Leyh
- Department of Gastroenterology and Hepatology, University Hospital and University of Duisburg-Essen, Essen, Germany
| | - Fabian Finkelmeier
- Department of Internal Medicine 1, Goethe-University Hospital Frankfurt, Frankfurt, Germany
| | - André Jefremow
- Department of Internal Medicine 1, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany,CCC-Erlangen EMN, Erlangen, Germany
| | - Kateryna Shmanko
- Department of Medicine I, University Medical Center Johannes Gutenberg University, Mainz, Germany
| | | | - Arne Kandulski
- Department of Internal Medicine I, Regensburg University Hospital, Regensburg, Germany
| | - Petia Jeliazkova
- Internal Medicine II, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Jan Best
- Department of Internal Medicine, University Hospital Knappschaftskrankenhaus, Ruhr-University Bochum, Bochum, Germany
| | - Thorben W. Fründt
- Department of Gastroenterology and Hepatology, University Medical Center, Hamburg, Germany
| | - Angela Djanani
- Department of Gastroenterology, Hepatology and Endocrinology, University Hospital of Innsbruck, Innsbruck, Austria
| | - Maria Pangerl
- Department of Internal Medicine I, University Medical Center Schleswig-Holstein (UKSH), Campus Kiel, Kiel, Germany
| | - Andreas Maieron
- Internal Medicine 2, Gastroenterology and Hepatology and Rheumatology, Karl Landsteiner University of Health Sciences, University Hospital of St. Pölten, St. Pölten, Austria
| | - Richard Greil
- Salzburg Cancer Research Institute, Department of Internal Medicine III with Hematology, Medical Oncology, Hemostaseology, Infectiology and Rheumatology, Oncologic Center, Erlangen, Germany
| | - Christina Fricke
- Internal Medicine 2, Gastroenterology and Hepatology and Rheumatology, Karl Landsteiner University of Health Sciences, University Hospital of St. Pölten, St. Pölten, Austria
| | - Disorn Sookthai
- Institut für Klinische Krebsforschung IKF GmbH, Frankfurt, Germany
| | - Rainer Günther
- Department of Internal Medicine I, University Medical Center Schleswig-Holstein (UKSH), Campus Kiel, Kiel, Germany
| | - Andreas Schmiderer
- Department of Gastroenterology, Hepatology and Endocrinology, University Hospital of Innsbruck, Innsbruck, Austria
| | - Henning Wege
- Department of Gastroenterology and Hepatology, University Medical Center, Hamburg, Germany
| | - Marino Venerito
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke-University Hospital Magdeburg, Magdeburg, Germany
| | - Ursula Ehmer
- Internal Medicine II, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Martina Müller
- Department of Internal Medicine I, Regensburg University Hospital, Regensburg, Germany
| | | | - Arndt Weinmann
- Department of Medicine I, University Medical Center Johannes Gutenberg University, Mainz, Germany
| | - Jürgen Siebler
- CCC-Erlangen EMN, Erlangen, Germany,Deutsches Zentrum Immuntherapie (DZI), Erlangen, Germany
| | - Oliver Waidmann
- Department of Internal Medicine 1, Goethe-University Hospital Frankfurt, Frankfurt, Germany
| | - Christian M. Lange
- Department of Gastroenterology and Hepatology, University Hospital and University of Duisburg-Essen, Essen, Germany
| | - Anna Saborowski
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Arndt Vogel
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany,*Arndt Vogel,
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