Real-world efficacy of lenvatinib plus PD-blockade in advanced hepatocellular carcinoma

The KEYNOTE-524 trial showed promising activity of lenvatinib plus pembrolizumab for unresectable hepatocellular carcinoma. Tumor occupation ≥ 50% volume of liver (TO ≥ 50%) and invasion in Vp4 were exclusion criteria in KEYNOTE-524. A study at two centers in China evaluated lenvatinib plus PD-1 blockade for unresectable HCC patients with these criteria. The study found that patients with TO ≥ 50% had significantly worse PFS and OS compared with patients with TO < 50%, while invasion in Vp4 did not affect PFS or OS. The authors conclude that lenvatinib plus PD-1 blockade can provide survival benefits for HCC patients with invasion in Vp4, and the indications of lenvatinib plus pembrolizumab may be further expanded. Locoregional treatments should be considered for patients with TO ≥ 50% during systemic therapy.