Loading
Cholangiocarcinoma and Gallbladder Cancer Studies / Hepatocellular Carcinoma Treatment and Prognosis · Journal article
Hepatology International · September 11, 2026
Encouraging direction, but not yet definitive.
This retrospective real-world comparison of 295 HCC patients receiving second-line lenvatinib or sorafenib after atezolizumab plus bevacizumab found lenvatinib associated with significantly longer overall survival, time to treatment discontinuation, and time to next treatment, with lower hepatotoxicity rates. However, the observational design without randomization means results should be viewed as hypothesis-generating rather than definitive; causality cannot be established.
Retrospective multicenter cohort study with propensity score matching. Patients with hepatocellular carcinoma who received second-line lenvatinib or sorafenib after first-line atezolizumab plus bevacizumab therapy. Intervention: Second-line lenvatinib. Compared with: Second-line sorafenib. n = 295. Korea (Liver Cancer IN Korea [LINK] database).
Median OS not reached for lenvatinib vs 6.67 months (95% CI 5.32–17.31) for sorafenib (p=0.001) TTD 5.49 months (3.75–6.04) with lenvatinib vs 1.84 months (1.68–2.20) with sorafenib (p<0.001) TTNT 5.72 months (4.07–7.85) with lenvatinib vs 3.06 months (2.56–3.48) with sorafenib (p=0.001)
Specific hepatotoxicity incidence rates not quantified numerically Incidence of laboratory-based hepatotoxicity lower with lenvatinib
The results suggest lenvatinib may offer survival and tolerability advantages over sorafenib as second-line therapy after immunotherapy-based first-line treatment in HCC. However, clinicians should recognize this is a real-world observational study; the authors themselves advocate for prospective randomized confirmation before changing practice.
Real-world retrospective comparison showing lenvatinib superior to sorafenib on OS and treatment durability after first-line immunotherapy in HCC, but observational design and potential confounding limit strength of evidence.
As stated by the source record.
Quoted from the source exactly as published.
The results suggest lenvatinib may offer survival and tolerability advantages over sorafenib as second-line therapy after immunotherapy-based first-line treatment in HCC. However, clinicians should recognize this is a real-world observational study; the authors themselves advocate for prospective randomized confirmation before changing practice.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
INTRODUCTION: After first‑line atezolizumab plus bevacizumab (ATE + BEV) in hepatocellular carcinoma (HCC), optimal second‑line (2L) therapy remains unclear. This study compared the real‑world effectiveness and hepatotoxicity of lenvatinib versus sorafenib as 2L treatment after ATE + BEV. METHODS: This retrospective, multicenter study used electronic medical record data from the Liver Cancer IN Korea (LINK) database. Patients who received 2L lenvatinib or sorafenib after ATE + BEV were included. The primary endpoint was overall survival (OS). Secondary endpoints included time to treatment discontinuation (TTD), time to next treatment (TTNT), hepatotoxicity, and tumor marker dynamics. Analyses were conducted in the overall cohort, with additional propensity score (PS)-matched analyses performed. RESULTS: A total of 295 patients were included in the analysis (2L lenvatinib, n = 132; 2L sorafenib, n = 163). Median OS was significantly longer with lenvatinib (not reached) than with sorafenib (6.67 months [95% CI 5.32-17.31]; p = 0.001). Lenvatinib also showed significantly longer TTD (5.49 months [3.75-6.04] vs. 1.84 months [1.68-2.20]; p < 0.001) and TTNT (5.72 months [4.07-7.85] vs. 3.06 months [2.56-3.48]; p = 0.001). These findings were generally consistent after PS-matching. Incidence rates of laboratory-based hepatotoxicity were lower with lenvatinib. From 2L initiation to 3 months after 2L therapy, both AFP and PIVKA-II generally declined in both groups. CONCLUSION: These findings suggest that lenvatinib may be a promising 2L option following ATE + BEV in HCC, as evidenced by improved OS, longer treatment durability, and lower rates of laboratory-based hepatotoxicity compared with sorafenib. However, given the retrospective observational design, further prospective studies are warranted to confirm these findings.
Taken from the source record, never inferred. Follow any of these and new work involving them reaches your briefing.