Camrelizumab plus rivoceranib superior to sorafenib for treatment of unresectable hepatocellular carcinoma

1. Patients in the camrelizumab-rivoceranib group reported significantly greater progression-free survival than the sorafenib group.

2. Treatment-related deaths were comparable among patients in either group.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Hepatocellular carcinoma comprises a predominant portion of primary liver malignancies. Immunotherapy combined with anti-angiogenic treatment has shown promise in various advanced solid tumors, but limited evidence exists for hepatocellular carcinoma. This randomized controlled trial aimed to compare the safety and efficacy of camrelizumab plus rivoceranib versus sorafenib for the treatment of unresectable hepatocellular carcinoma. The primary outcome was progression-free survival while key secondary outcomes were overall survival and disease control rate. According to study results, camrelizumab plus rivoceranib significantly improved progression-free survival and overall survival compared to sorafenib. Although this study was well done, it was limited by a relatively short follow-up duration, affecting the validity of the results.

Click to read the study in The Lancet

Relevant Reading: Atezolizumab plus Bevacizumab in Unresectable Hepatocellular Carcinoma

In-depth [randomized-controlled trial]: Between Jun 28, 2019, and Mar 24, 2021, 842 patients were screened for eligibility at 95 study sites across 13 countries. Included were patients with unresectable or metastatic hepatocellular carcinoma who had not previously received systemic treatment. Altogether, 543 patients (272 to camrelizumab–rivoceranib and 271 to sorafenib) were included in the final analysis. The primary outcome of progression-free survival was significantly greater for the camrelizumab–rivoceranib group compared to the sorafenib group (5.6 months vs. 3.7 months, hazard ratio [HR] 0.52, p<0.0001). This was also the case for the secondary outcome of overall survival (22.1 months with camrelizumab-rivoceranib vs. 15.2 months with sorafenib, HR 0.62). The objective response rate was significantly increased with camrelizumab-rivoceranib (25%) compared to sorafenib (6%). Overall, findings from this study suggest that camrelizumab plus rivoceranib is a new and effective first-line treatment option for unresectable hepatocellular carcinoma, significantly improving both progression-free and overall survival.

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