ArticleQuantitative imaging in medicine and surgery2026
Lenvatinib continuation versus regorafenib in treating hepatocellular carcinoma after lenvatinib failure.
Article in Quantitative imaging in medicine and surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Hepatocellular carcinoma (HCC) represents a major global health burden. Despite lenvatinib's established role as first-line therapy for advanced HCC, the optimal sequential strategy after its failure remains uncertain. This study compared the efficacy and safety of lenvatinib continuation versus switching to regorafenib following first-line lenvatinib progression. Methods: A retrospective analysis was conducted on 107 consecutive HCC patients treated with lenvatinib. Patients were divided into two groups based on their second-line treatment: the regorafenib group (LEN-RG, 49 patients) and the lenvatinib continuation group (LEN-CON, 58 patients). Baseline characteristics were collected, and overall survival (OS), post-progression survival (PPS), total progression-free survival (TPFS), and post-second-line progression-free survival (PFS) were assessed. Results: The median OS for the LEN-CON group was 34.4 months [95% confidence interval (CI): 22.4-46.4], compared to 21.8 months (95% CI: 18.56-25.05) in the LEN-RG group [hazard ratio (HR) 0.64, 95% CI: 0.40-1.02, P=0.058]. The median PPS was 25.87 months (95% CI: 15.35-36.38) in the LEN-CON group, compared to 15.33 months (95% CI: 7.39-23.28) in the LEN-RG group (HR 0.58, 95% CI: 0.37-0.93, P=0.019). No significant differences were observed between the groups in TPFS or Post-Second-Line PFS. Multivariate analysis identified Eastern Cooperative Oncology Group (ECOG), extrahepatic metastasis, combined programmed cell death 1 (PD-1) therapy, nodule number, and treatment strategy as independent prognostic factors for PPS. Subgroup analysis indicated clinical benefits in PPS for LEN-CON patients with ECOG 0, Child-Pugh A, male gender, combined PD-1 therapy, multiple tumors, and alpha-fetoprotein (AFP) ≤400 ng/mL. Common adverse events (AEs) were similar between the two groups, with elevated ALT more frequent in the LEN-RG group. Conclusions: Continuing lenvatinib as second-line therapy after failure may offer sustained survival benefits and demonstrate favorable efficacy and safety in real-world clinical practice.
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