ABSTRACT Introduction Lenvatinib is approved as a first‐line treatment for unresectable hepatocellular carcinoma (HCC), but real‐world outcomes may vary due to patient heterogeneity. This study aimed to evaluate the real‐world efficacy of lenvatinib in Taiwanese patients and to identify prognostic factors influencing outcomes. Methods This retrospective cohort study included 111 patients with unresectable HCC treated with the first‐line lenvatinib between February 2020 and April 2023 at Taichung Veterans General Hospital. All patients were Child‐Pugh class A and had at least one measurable lesion per mRECIST. Radiological tumor response, overall survival (OS), and progression‐free survival (PFS) were recorded and analyzed. Results The ORR and DCR were 36% and 81% respectively. The median OS of all patients was 17 months, and PFS was 10 months. Patients with ALBI grade 1 (HR 0.45, 95% CI 0.24–0.84, p = 0.011) and receiving combined locoregional therapy (LRT) (HR 0.38, 95% CI 0.20–0.79, p = 0.003) had significantly longer OS. AFP ≤ 400 ng/mL was associated with longer PFS (HR 0.35, 95% CI 0.35–0.94, p = 0.028). Conclusion Lenvatinib is effective in real‐world treatment of unresectable HCC, especially when combined with LRT. ALBI grade 1 and AFP ≤ 400 ng/mL are favorable prognostic indicators for survival and disease control. These findings support personalized treatment strategies and warrant further prospective validation.
Lee et al. (Fri,) studied this question.