Clinical Profile and Outcome of Patients With Advanced Hepatocellular Carcinoma (HCC) Taking Sorafenib or Lenvatinib: Real-World Experience From a Low-Middle Resource Country.
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Background and objective Hepatocellular carcinoma (HCC) incidence is high in Asian countries, and the age-standardized ratio in Pakistan is 7.6/100000 for males and 2.8/100000 for females, where patients often present with advanced-stage disease due to limited early detection. While the tyrosine kinase inhibitor sorafenib has been the standard first-line therapy, another tyrosine kinase inhibitor, lenvatinib, has recently gained attention as a potential alternative. However, local data comparing their effectiveness and safety is scarce. The aim of the study was to assess the clinical profile of patients with advanced HCC and treatment outcomes with sorafenib or lenvatinib in a tertiary care setting in Pakistan. Methods This retrospective, data-based study was conducted at the Department of Medical Oncology, Nawaz Sharif Social Security Teaching Hospital, Lahore, Pakistan. Medical records of 104 patients classified as having Barcelona clinic liver cancer (BCLC) stage C HCC were included. Patients with incomplete medical records, missing essential clinical data, those lost to follow-up, or who died before initiation of treatment were excluded from the analysis. Demographic information, including age, gender, hepatitis B and C status, and co-morbid conditions, was evaluated. For documentation of baseline parameters, Eastern Cooperative Oncology Group (ECOG) performance status, number of lesions on CT scan, evidence of invasive or metastatic disease, and liver function parameters categorized by Child-Pugh class (A to C) were assessed. Treatment records were examined to determine whether patients received Sorafenib or Lenvatinib, and the outcome and adverse effects were noted. Results of follow-up CT scan performed at six months were used as the primary outcome measure to assess disease status, categorized as complete resolution, partial resolution, or no response/progression. Data were entered and analyzed using SPSS version 23 (IBM Inc., Armonk, New York). Results The mean age of the patients was 64.9±8.3 years, with 74 (71.2%) males. All patients had advanced HCC at BCLC stage C. Chronic hepatitis C was reported in 92 (88.5%) patients, while chronic hepatitis B in 02 (1.9%). The most frequent co-morbid conditions were hypertension (26, 25.0%) and diabetes mellitus (18, 17.3%). The majority of the patients (40, 38.5%) had grade 2 ECOG performance status, with 68 (65.4%) having multifocal HCC and 62 (59.6%) vascular invasion. Metastases were seen in 38 (36.5%) patients, with nodal metastasis being the most frequent site (18, 17.3%). The mean Child-Pugh score was 6.5±1.3, with the majority of the patients (62, 59.6%) having Child-Pugh class A. With regards to treatment, 66 (63.5%) patients received sorafenib while 38 (36.5%) received lenvatinib. At the six-month follow-up, repeat CT scan demonstrated complete resolution of HCC in 04 (3.8%) patients and partial resolution in 58 (55.8%) patients, whereas 42 (40.4%) patients showed no response or progression. Hand-foot syndrome was the most frequent adverse effect seen in eight (7.7%) patients, followed by diarrhea in four (3.8%) patients, and mucositis in two (1.9%) patients. Conclusion In this study, sorafenib and lenvatinib were both found to be effective treatment options for patients with advanced HCC at BCLC stage C, with partial resolution observed in the majority of patients.