Experience of using lenvatinib in the treatment of hepatocellular cancer at the Republican Oncology Center of the Republic of North Ossetia-Alania in 2018–2022. Balance of efficiency and accessibility in regional practice

The overall incidence of liver cancer in the Republic of North Ossetia-Alania has remained stable over the past five years. Moreover, the initial diagnostic of HCC occurs at widespread stage, which limits the possibilities of cured therapy. The Republican Oncology Clinic has accumulated experience in using the drug lenvatinib for advanced and metastatic hepatocellular cancer. In the realities of a small regional dispensary, and has to find a balance between efficiency and availability of therapeutic options to provide effective therapy for all patients. The authors conducted a single-center retrospective analysis of the effectiveness and safety of lenvatinib in real clinical practice in patients with hepatocellular cancer at the Republican Oncology Center of the Republic of North Ossetia Alania. The analysis included 18 patients with HCC who received lenvatinib monotherapy. 11(61%) patients had concomitant viral hepatitis B or C, 15 (83%) had distant metastases to the lymph nodes, lungs, adrenal glands or other organs. A feature of this patient population is the long period of time from the prescription of drug therapy for HCC to its actual start – on average 46 days, with a range from 5 to 100 days. We believe that a delay in initiating therapy may affect the results obtained. Median PFS in 1st line of lenvatinib therapy was 10.1 months (2.3 months to 13.1 months). Median PFS2 (defined as the time from 1st line treatment on lenvatinib to progression on first subsequent therapy) was 19.1 months. 6 (33%) patients received lenvatinib in the second line after progression on another drug therapy. The median second-line PFS in this case was 5.9 months (3.8 months‑7.7 months). Lenvatinib had a manageable and predictable tolerability profile. No new safety signals were identified. Conclusion: The use of lenvatinib as monotherapy in adult patients with advanced or unresectable hepatocellular carcinoma has proven to be an effective strategy that balances clinical benefit and availability of the drug.