Liver Cancer (Oct 2020)

Lenvatinib-Transarterial Chemoembolization Sequential Therapy as an Effective Treatment at Progression during Lenvatinib Therapy for Advanced Hepatocellular Carcinoma

  • Yusuke Kawamura,
  • Masahiro Kobayashi,
  • Junichi Shindoh,
  • Yuta Kobayashi,
  • Satoshi Okubo,
  • Licht Tominaga,
  • Akira Kajiwara,
  • Kayoko Kasuya,
  • Soichi Iritani,
  • Shunichiro Fujiyama,
  • Tetsuya Hosaka,
  • Satoshi Saitoh,
  • Hitomi Sezaki,
  • Norio Akuta,
  • Fumitaka Suzuki,
  • Yoshiyuki Suzuki,
  • Kenji Ikeda,
  • Yasuji Arase,
  • Masaji Hashimoto,
  • Tokuyo Kozuka,
  • Hiromitsu Kumada

DOI
https://doi.org/10.1159/000510299
Journal volume & issue
Vol. 9, no. 6
pp. 756 – 770

Abstract

Read online

Background: The aims of this study were to evaluate the efficacy of additional treatment, especially lenvatinib-transarterial chemoembolization (TACE) sequential therapy, for unresectable hepatocellular carcinoma (HCC). Methods: Consecutive 56 patients who underwent lenvatinib treatment were reviewed. Oncological aggressiveness of tumor was estimated using a dynamic CT enhancement pattern classification, and clinical impact of subsequent treatment was investigated through analysis of progression-free survival (PFS), post-progression survival (PPS), and multivariate analysis of potential confounders for survival after progression during lenvatinib therapy. Results: Heterogeneous enhancement patterns (Type-3 and -4), which are reportedly associated with higher oncological aggressiveness of HCC, were associated with better objective response to lenvatinib compared to homogeneous enhancement pattern (Type-2) (86 and 85% vs. 53% in modified Response Evaluation Criteria in Solid Tumors), resulting in similar PFS (p = 0.313). Because of significantly worse PPS, overall survival of Type-4 tumor was poor compared to Type-2 or -3 tumors (p = 0.009). However, subgroup of patients who achieved subsequent treatment showed significantly better PPS, regardless of CT enhancement pattern. Multivariate analysis confirmed that use of lenvatinib-TACE sequential treatment after progression during lenvatinib therapy was associated with better PPS (hazard ratio [HR], 0.08; 95% CI, 0.01–0.71; p = 0.023), while Type-4 enhancement pattern was correlated with worse PPS (HR, 2.92; 95% CI, 1.06–8.05; p = 0.039). Conclusion: Oncological aggressiveness of HCC estimated by CT enhancement pattern was predictive of PPS after progression during lenvatinib. Successful subsequent treatment with lenvatinib-TACE sequential therapy may offer survival benefit regardless of CT enhancement pattern of HCC.

Keywords