Title: Comparison of the outcomes between sorafenib and lenvatinib as the first-line systemic
treatment for HBV-associated hepatocellular carcinoma: a propensity score matching analysis
Version: 2 Date: 24 Oct 2021
Reviewer's report:
This retrospective single-center study used PMS to compare sorafenib and lenvatinib in the first-
line treatment of HBV-related HCC, which showed comparable OS and PFS, but longer TTP
and better tumor response with lenvatinib treatment.
Several points I raised for the authors.
Major:
1. This study focused on HBV-HCC, but the repeat of similar result makes it lack novelty.
There are already two real-world data published for the comparison of sorafenib and lenvatinib
(Reference 22 and 23 in this manuscript). Casadei-Gardini et. al. balanced clinical features by
using inverse probability of treatment weighting (IPTW) methodology, which enrolled more
patients and showed similar results as REFLECT study, including HBV-HCC in subgroup
analysis (Reference 23).
2. Lenvatinib demonstrated higher ORR and longer PFS but similar OS. There is not much data
to explain this finding. The authors may be able to analyze and explain why from their real-
world data.
3. In Discussion Section 1-3, the author repeatedly mentioned the data in the Result Section
that is redundant. In other part of Discussion, the author only compared the data between this
study and other studies with few discussions, which makes these sections lacking in elaboration.
Generally, the Discussion Section should be re-written with a more scientific way.
4. In Discussion Section 9, the authors stated that “These observations may help in the selection
of sorafenib or lenvatinib as a first-line systemic treatment for patients with uHCC associated
with HBV infection” according to the subgroup analysis finding “Lenvatinib was preferred for
patients # 60 years of age and AFP > 200 ng/mL for PFS, and sorafenib was preferred in patients
> 60 years of age, AFP # 200 ng/mL, and tumor size # 5 cm for OS”. In fact, it is not convincing
using the subgroup analysis data to make such conclusion.
5. The authors did the multivariant analysis for OS with their matched cohort. This analysis
seems to be biased. They should consider used their un-matched cohort to do this analysis.
Minor:
1. Table 3 showed “Previous and post anti-HCC treatment”. It is not clear what it means.
Title: Comparison of the outcomes between sorafenib and lenvatinib as the first-line systemic
treatment for HBV-associated hepatocellular carcinoma: a propensity score matching analysis
Version: 2 Date: 24 Oct 2021
Reviewer's report:
This retrospective single-center study used PMS to compare sorafenib and lenvatinib in the first-
line treatment of HBV-related HCC, which showed comparable OS and PFS, but longer TTP
and better tumor response with lenvatinib treatment.
Several points I raised for the authors.
Major:
1. This study focused on HBV-HCC, but the repeat of similar result makes it lack novelty.
There are already two real-world data published for the comparison of sorafenib and lenvatinib
(Reference 22 and 23 in this manuscript). Casadei-Gardini et. al. balanced clinical features by
using inverse probability of treatment weighting (IPTW) methodology, which enrolled more
patients and showed similar results as REFLECT study, including HBV-HCC in subgroup
analysis (Reference 23).
2. Lenvatinib demonstrated higher ORR and longer PFS but similar OS. There is not much data
to explain this finding. The authors may be able to analyze and explain why from their real-
world data.
3. In Discussion Section 1-3, the author repeatedly mentioned the data in the Result Section
that is redundant. In other part of Discussion, the author only compared the data between this
study and other studies with few discussions, which makes these sections lacking in elaboration.
Generally, the Discussion Section should be re-written with a more scientific way.
4. In Discussion Section 9, the authors stated that “These observations may help in the selection
of sorafenib or lenvatinib as a first-line systemic treatment for patients with uHCC associated
with HBV infection” according to the subgroup analysis finding “Lenvatinib was preferred for
patients # 60 years of age and AFP > 200 ng/mL for PFS, and sorafenib was preferred in patients
> 60 years of age, AFP # 200 ng/mL, and tumor size # 5 cm for OS”. In fact, it is not convincing
using the subgroup analysis data to make such conclusion.
5. The authors did the multivariant analysis for OS with their matched cohort. This analysis
seems to be biased. They should consider used their un-matched cohort to do this analysis.
Minor:
1. Table 3 showed “Previous and post anti-HCC treatment”. It is not clear what it means.
Please review this paper.
user
Title: Comparison of the outcomes between sorafenib and lenvatinib as the first-line systemic
treatment for HBV-associated hepatocellular carcinoma: a propensity score matching analysis
Version: 2 Date: 24 Oct 2021
Reviewer's report:
This retrospective single-center study used PMS to compare sorafenib and lenvatinib in the first-
line treatment of HBV-related HCC, which showed comparable OS and PFS, but longer TTP
and better tumor response with lenvatinib treatment.
Several points I raised for the authors.
Major:
1. This study focused on HBV-HCC, but the repeat of similar result makes it lack novelty.
There are already two real-world data published for the comparison of sorafenib and lenvatinib
(Reference 22 and 23 in this manuscript). Casadei-Gardini et. al. balanced clinical features by
using inverse probability of treatment weighting (IPTW) methodology, which enrolled more
patients and showed similar results as REFLECT study, including HBV-HCC in subgroup
analysis (Reference 23).
2. Lenvatinib demonstrated higher ORR and longer PFS but similar OS. There is not much data
to explain this finding. The authors may be able to analyze and explain why from their real-
world data.
3. In Discussion Section 1-3, the author repeatedly mentioned the data in the Result Section
that is redundant. In other part of Discussion, the author only compared the data between this
study and other studies with few discussions, which makes these sections lacking in elaboration.
Generally, the Discussion Section should be re-written with a more scientific way.
4. In Discussion Section 9, the authors stated that “These observations may help in the selection
of sorafenib or lenvatinib as a first-line systemic treatment for patients with uHCC associated
with HBV infection” according to the subgroup analysis finding “Lenvatinib was preferred for
patients # 60 years of age and AFP > 200 ng/mL for PFS, and sorafenib was preferred in patients
> 60 years of age, AFP # 200 ng/mL, and tumor size # 5 cm for OS”. In fact, it is not convincing
using the subgroup analysis data to make such conclusion.
5. The authors did the multivariant analysis for OS with their matched cohort. This analysis
seems to be biased. They should consider used their un-matched cohort to do this analysis.
Minor:
1. Table 3 showed “Previous and post anti-HCC treatment”. It is not clear what it means.
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