Abstract 183P
Background
Hepatocellular carcinoma (HCC) recurs after liver transplantation (LT) in ∼15% of patients. We compare two tyrosine-kinase inhibitors (TKIs) for recurrent HCC post-LT and their impact on overall survival.
Methods
Patients receiving LT for HCC between 2006-2019 were included. The impact of effect of the treatment was assessed through survival analysis with an a priori multivariable Cox regression proportional hazard ratio (alpha-Fetoprotein [AFP] at recurrence, recurrence lesion diameter, oligometastasis recurrence) starting at time of treatment.
Results
754 patients underwent LT, of which 120 (15.9%) developed HCC recurrence. Of these, 42 received sorafenib and 14 lenvatinib. The median age at recurrence was 62.0years (IQR:57.5,65.5), 52 (93%) male, 16 (29%) documented pre-transplant hepatitis C virus positivity. Median follow-up post-LT 42.4months (IQR:22.2,86.3), time from LT to recurrence was 12.2months (IQR:6.9,27.1). Comparing the lenvatinib vs sorafenib group, significant different AFP at recurrence (3[IQR:2,5] vs 95ug/L [IQR:6,865]; p<0.001) was seen. There were no significant differences in lesion diameter (2.3 [IQR:1.1,4.0] vs 3.3cm [IQR:2.0,4.8]; p=0.202), rate of oligometastasis (5 [36%] vs 15 [36%]; p=1.000), rate of interventional treatment before start of TKI (11 [79%] vs 25 [60%]; p=0.334), time from recurrence to interventional treatment (2.5 [IQR:2.1,3.8] vs 1.9months [IQR:1.2,3.2]; p=0.144), or time from interventional treatment to TKI (20.8 [IQR:3.0,23.7] vs 7.7months [IQR:4.6,12.7] ; p=0.435) was observed. The median overall survival (OS) after initiation of TKI treatment was longer in the lenvatinib group (15.0 [95%CI:11.5,31.5] vs 7.8months [95%CI:4.0,15.4]; p=0.017) with double OS estimated effect in the a priori adjusted analysis (aHR 2.41 [95%CI: 1.06, 5.50]; p=0.036) and a non-significant numerical difference at 5 years (21% vs 2.7%; aHR 1.67; 95%CI: 0.75, 3.73; p=0.211). Duration of TKI was not significantly different (4.2 [IQR:2.5,9.3] vs 2.8months [IQR:1.2,5.3]; p=0.170). In 6 (10.7%) patients a switch to other systemic treatments was performed.
Conclusions
Our findings suggest lenvatinib may result in improved OS compared to sorafenib for patients with HCC recurrence after LT.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
S. Perera: Financial Interests, Institutional, Invited Speaker: AstraZeneca, Amgen; Financial Interests, Institutional, Advisory Board: Taiho, Eisai. J.J. Knox: Financial Interests, Personal and Institutional, Research Grant: Roche, AstraZeneca, Ibsen, Merck. G.M. O'Kane: Financial Interests, Institutional, Research Grant: Roche, AstraZeneca; Financial Interests, Institutional, Advisory Board: Servier, Incyte; Financial Interests, Personal and Institutional, Invited Speaker: Roche; Financial Interests, Personal and Institutional, Sponsor/Funding, support for attending meetings: MSD, Roche. G. Sapisochin: Financial Interests, Personal, Advisory Board: AstraZeneca, Roche, HeparRegeniX; Financial Interests, Personal, Invited Speaker: AstraZeneca, Integra, Chiesi; Financial Interests, Personal, Other, Research study: Novartis; Financial Interests, Personal, Stocks/Shares: Amgen, CVS Health, Gilead, J&J, Merck, Pfizer, UnitedHealth; Financial Interests, Institutional, Invited Speaker: AstraZeneca; Financial Interests, Institutional, Funding: Roche, Stryker. All other authors have declared no conflicts of interest.