Title: Use of ramucirumab for various treatment linesin real-world practice of patients with
advanced hepatocellular carcinoma
Version: 0 Date: 04 Dec 2022
Reviewer's report:
The authors aimed to retrospectively assess the treatment outcomes of ramucirumab
administered to advanced HCC patients after diverse systemic therapies.
Radiological assessments were determined according to both Response Evaluation Criteria in
Solid Tumours (RECIST) version 1.1 and modified RECIST and the Common Terminology
Criteria for Adverse Events version 5.0 was used to assess adverse events.
Overall,  37 patients treated with ramucirumab between June 2019 and March 2021 were studied.
Importantly, Ramucirumab was administered in very different setting (as second, third, fourth,
and fifth-line treatment in 35.1%, 37.8%, 21.6%, and 5.4%patients, respectively. Most patients
(29.7%) who received ramucirumab as a second-line therapy were pretreated with lenvatinib.
The median progression-free survival of patients treated with ramucirumab was 2.7 months.
There were no notable adverse events and no significant changes in albumin bilirubin score
during ramucirumab treatment.
They concluded that, although ramucirumab was used for various lines of treatment other than
second-line immediately after sorafenib, its safety and efficacy were not significantly different
from the findings of the REACH-2 trial.
The study has a potential clinical interest. However, while the reported experience in distinct
lines of therapy could be of interest from the safety point of view, very limited conclusions can
be drawn regarding the efficacy due to the differences in enrolled patients, lines of therapy, and
of course front-line therapy (sorafenib vs lenvatinib).
I would suggest focusing the results and discussion only on the safety profile as the reported
experience in the different settings may offer important clinical value.
For the same reasons, the authors should discuss and compare the available experience of other
TKI in the clinical practice, especially for regorafenib and cabozantinib which have a wide range
of real-world experience as recently reported (Experience with regorafenib in the treatment of
hepatocellular carcinoma. Therap Adv Gastroenterol. 2021 May 28;14:17562848211016959;
Real-Life Clinical Data of Cabozantinib for Unresectable Hepatocellular Carcinoma. Liver
Cancer. 2021 Jul;10(4):370-379).
Title: Use of ramucirumab for various treatment linesin real-world practice of patients with
advanced hepatocellular carcinoma
Version: 0 Date: 04 Dec 2022
Reviewer's report:
The authors aimed to retrospectively assess the treatment outcomes of ramucirumab
administered to advanced HCC patients after diverse systemic therapies.
Radiological assessments were determined according to both Response Evaluation Criteria in
Solid Tumours (RECIST) version 1.1 and modified RECIST and the Common Terminology
Criteria for Adverse Events version 5.0 was used to assess adverse events.
Overall,  37 patients treated with ramucirumab between June 2019 and March 2021 were studied.
Importantly, Ramucirumab was administered in very different setting (as second, third, fourth,
and fifth-line treatment in 35.1%, 37.8%, 21.6%, and 5.4%patients, respectively. Most patients
(29.7%) who received ramucirumab as a second-line therapy were pretreated with lenvatinib.
The median progression-free survival of patients treated with ramucirumab was 2.7 months.
There were no notable adverse events and no significant changes in albumin bilirubin score
during ramucirumab treatment.
They concluded that, although ramucirumab was used for various lines of treatment other than
second-line immediately after sorafenib, its safety and efficacy were not significantly different
from the findings of the REACH-2 trial.
The study has a potential clinical interest. However, while the reported experience in distinct
lines of therapy could be of interest from the safety point of view, very limited conclusions can
be drawn regarding the efficacy due to the differences in enrolled patients, lines of therapy, and
of course front-line therapy (sorafenib vs lenvatinib).
I would suggest focusing the results and discussion only on the safety profile as the reported
experience in the different settings may offer important clinical value.
For the same reasons, the authors should discuss and compare the available experience of other
TKI in the clinical practice, especially for regorafenib and cabozantinib which have a wide range
of real-world experience as recently reported (Experience with regorafenib in the treatment of
hepatocellular carcinoma. Therap Adv Gastroenterol. 2021 May 28;14:17562848211016959;
Real-Life Clinical Data of Cabozantinib for Unresectable Hepatocellular Carcinoma. Liver
Cancer. 2021 Jul;10(4):370-379).
Please review this paper.
user
Title: Use of ramucirumab for various treatment linesin real-world practice of patients with
advanced hepatocellular carcinoma
Version: 0 Date: 04 Dec 2022
Reviewer's report:
The authors aimed to retrospectively assess the treatment outcomes of ramucirumab
administered to advanced HCC patients after diverse systemic therapies.
Radiological assessments were determined according to both Response Evaluation Criteria in
Solid Tumours (RECIST) version 1.1 and modified RECIST and the Common Terminology
Criteria for Adverse Events version 5.0 was used to assess adverse events.
Overall,  37 patients treated with ramucirumab between June 2019 and March 2021 were studied.
Importantly, Ramucirumab was administered in very different setting (as second, third, fourth,
and fifth-line treatment in 35.1%, 37.8%, 21.6%, and 5.4%patients, respectively. Most patients
(29.7%) who received ramucirumab as a second-line therapy were pretreated with lenvatinib.
The median progression-free survival of patients treated with ramucirumab was 2.7 months.
There were no notable adverse events and no significant changes in albumin bilirubin score
during ramucirumab treatment.
They concluded that, although ramucirumab was used for various lines of treatment other than
second-line immediately after sorafenib, its safety and efficacy were not significantly different
from the findings of the REACH-2 trial.
The study has a potential clinical interest. However, while the reported experience in distinct
lines of therapy could be of interest from the safety point of view, very limited conclusions can
be drawn regarding the efficacy due to the differences in enrolled patients, lines of therapy, and
of course front-line therapy (sorafenib vs lenvatinib).
I would suggest focusing the results and discussion only on the safety profile as the reported
experience in the different settings may offer important clinical value.
For the same reasons, the authors should discuss and compare the available experience of other
TKI in the clinical practice, especially for regorafenib and cabozantinib which have a wide range
of real-world experience as recently reported (Experience with regorafenib in the treatment of
hepatocellular carcinoma. Therap Adv Gastroenterol. 2021 May 28;14:17562848211016959;
Real-Life Clinical Data of Cabozantinib for Unresectable Hepatocellular Carcinoma. Liver
Cancer. 2021 Jul;10(4):370-379).
assistant