Comparative analysis of liver functional reserve during lenvatinib and sorafenib for advanced hepatocellular carcinoma

Aim Most patients with advanced hepatocellular carcinoma (HCC) have underlying chronic liver disease, which potentially deteriorated the liver functional reserve that often affects the patients' clinical course. We investigated and compared the changes in liver functional reserve during lenvatinib or sorafenib therapy in patients with advanced HCC. Methods We prospectively collected medical information about patients with advanced HCC with a Child–Pugh score of 5–7 to compare the liver functional reserve during treatment in those who were treated with lenvatinib or sorafenib. We also evaluated the effect of the change in the liver functional reserve on patients' outcome. Moreover, we analyzed the contributing factors for maintaining the liver functional reserve during treatment. Results Patients were treated with lenvatinib (n = 45) or sorafenib (n = 157). Forty‐five patients in the lenvatinib group and 135 patients in the sorafenib group were selected through a propensity score matching analysis. More patients treated with lenvatinib had a Child–Pugh score that was maintained or improved after 4 and 12 weeks compared with those treated with sorafenib (P = 0.048, P = 0.036, respectively). Lenvatinib was identified as one of the variables that was associated with maintaining Child–Pugh scores. Multivariate analysis revealed that a worsened Child–Pugh score after 4 weeks was an independent unfavorable predictive factor for overall survival. Conclusions More patients treated with lenvatinib for advanced HCC maintained their liver functional reserves compared with those treated with sorafenib. Maintaining the liver functional reserve contributed to better outcomes for patients with advanced HCC.