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Patients with advanced HCC are candidates for systemic treatment. There are two tyrosine kinase inhibitors (TKIs), which are approved for first-line use in HCC: lenvatinib and sorafenib. Lenvatinib may have a more potent vascular endothelial growth factor receptor (VEGFR)-inhibiting activity than sorafenib, and it targets other receptors that are not targeted by sorafenib such as FGFR1 to 4, KIT, and RET. Lenvatinib was noninferior to sorafenib in terms of overall survival (OS) in the REFLECT study. With newer, emerging immunotherapies showing efficacy over sorafenib in the first-line setting, more prospective data is needed for the use of the traditional “first-line TKIs” as “second-line” treatments after front-line immunotherapy. Nonetheless, for patients with contraindications to immunotherapy, such as transplantation and uncontrolled autoimmune conditions, lenvatinib and sorafenib remain the mainstay in the first-line setting for the treatment of advanced HCC.

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Should All Tyrosine Kinase Inhibitors Be Considered Equal for First-Line Hepatocellular Carcinoma Treatment?

  • 章节

  • 发表日期：

    2025年

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  • Naim Alkhouri,
  • Sukeshi Patel Arora

摘要

Patients with advanced HCC are candidates for systemic treatment. There are two tyrosine kinase inhibitors (TKIs), which are approved for first-line use in HCC: lenvatinib and sorafenib. Lenvatinib may have a more potent vascular endothelial growth factor receptor (VEGFR)-inhibiting activity than sorafenib, and it targets other receptors that are not targeted by sorafenib such as FGFR1 to 4, KIT, and RET. Lenvatinib was noninferior to sorafenib in terms of overall survival (OS) in the REFLECT study. With newer, emerging immunotherapies showing efficacy over sorafenib in the first-line setting, more prospective data is needed for the use of the traditional “first-line TKIs” as “second-line” treatments after front-line immunotherapy. Nonetheless, for patients with contraindications to immunotherapy, such as transplantation and uncontrolled autoimmune conditions, lenvatinib and sorafenib remain the mainstay in the first-line setting for the treatment of advanced HCC.