Efficacy and safety comparison between Lenvatinib and Sorafenib in hepatocellular carcinoma treatment: a systematic review and meta-analysis of real-world study

OBJECTIVE: Our study aimed to evaluate the efficacy and safety of Lenvatinib compared with Sorafenib for treating hepatocellular carcinoma (HCC) patients under real-world setting. METHODS: We retrieved relevant literature through the PubMed, Embase, Web of Science, and Cochrane Library databases from 1 January 2000 to 25 June 2022. The differences in overall survival (OS), progression-free survival (PFS), objective response rate (ORR), disease control rate (DCR) as well as treatment adverse related events were evaluated between HCC patients treated with Lenvatinib and Sorafenib using fixed or random-effects models. The MINORS evaluation questionnaire was used to assess the quality of the included literature. RESULTS: This meta-analysis included a total of 9 single-arm studies and 6 comparative studies. In the meta-analysis, Lenvatinib showed significantly longer median OS than Sorafenib (P < 0.01, MD = 1.20, 95% CI [0.92–1.48]), as well as median PFS (P < 0.01, OR = 2.68, 95% CI [1.59–3.76]), and higher ORR(P < 0.01, OR = 5.36, 95% CI [3.42–8.40]), DCR(P < 0.01, OR = 2.17, 95% CI [1.64–2.86]). The occurrence of Hypertension was higher in Lenvatinib than in Sorafenib treatment (P < 0.01, MD = 5.27, 95% CI [2.38–11.66]), and there was no significant difference in Hand-foot syndrome between Lenvatinib and Sorafenib. CONCLUSION: We found that treatment with Lenvatinib in HCC patients resulted in better OS, PFS, and higher ORR and DCR compared to Sorafenib. However, safety data indicated that Lenvatinib did not exhibit a significant advantage.