Conversion hepatectomy for advanced hepatocellular carcinoma after right portal vein transection and lenvatinib therapy

Ohya, Yuki; Hayashida, Shintaro; Tsuji, Akira; Kuramoto, Kei; Shibata, Hidekatsu; Setoyama, Hiroko; Hayashi, Hironori; Kuriwaki, Kazumi; Sato, Masato; Iizaka, Masayoshi; Nakahara, Osamu; Inomata, Yukihiro

doi:10.1186/s40792-020-01078-3

Cited by 25 publications

(16 citation statements)

References 20 publications

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“…In addition, no significant macrophage accumulation was observed in the other TACE + LEN cases 6 ,. 12 Therefore, it was not clear whether the accumulation of foamy macrophages was a characteristic reaction to LEN. As foamy macrophages are a type of inflammatory cell, the cells that infiltrate the tissue might be affected by the type of treatment and the time course.…”

Section: Discussionmentioning

confidence: 99%

Two hepatectomy cases for initially unresectable hepatocellular carcinoma after achieving a radiological complete response to sequential therapy with lenvatinib and transcatheter arterial chemoembolization

Endo

Kuroda

Abe

et al. 2021

Hepatology Research

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We herein report two cases of locally advanced unresectable hepatocellular carcinoma (u‐HCC) that were resected after achieving a radiological complete response to initially administered lenvatinib followed by transcatheter arterial chemoembolization (LEN‐TACE sequential therapy). A 78‐year‐old woman and an 80‐year‐old man with HCC of Barcelona Clinic Liver Cancer classification stage C were treated for 15 and 14 months with lenvatinib, respectively. Both patients were subsequently treated with TACE, resulting in complete remission on imaging. The α‐fetoprotein level in the woman and man decreased markedly from 9370 ng/ml to 46 ng/ml and from 6380 ng/ml to 3 ng/ml, respectively, leading to hepatectomy. A histopathological examination showed coagulative necrosis of the entire HCC in one case, while the other showed a small population of viable HCC cells. The results showed that LEN‐TACE sequential therapy has a synergic effect and could be a promising option for locally advanced u‐HCC.

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Section: Discussionmentioning

confidence: 99%

Two hepatectomy cases for initially unresectable hepatocellular carcinoma after achieving a radiological complete response to sequential therapy with lenvatinib and transcatheter arterial chemoembolization

Endo

Kuroda

Abe

et al. 2021

Hepatology Research

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“…Some cases that were successfully converted to downstaging hepatectomy after the preoperative administration of the TKIs sorafenib and lenvatinib have been reported[ 21 - 23 ]. Although these cases were successfully treated with conversion hepatectomy, the actual conversion rate due to the downstaging effects of TKIs remains unknown, and the response rate of HCC to TKI therapy (a complete response rate of 2% and a partial response rate of 38% can be achieved with lenvatinib[ 6 ]) is still insufficient to enable TKIs to be used for downstaging purposes as part of the standard treatment strategy for advanced HCC.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of reduction hepatectomy combined with postoperative multidisciplinary therapy for advanced hepatocellular carcinoma

Asahi¹,

Kamiyama²,

Kakisaka³

et al. 2021

WJGS

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BACKGROUND The prognosis of advanced hepatocellular carcinoma (HCC) that is not indicated for curative hepatectomy remains poor, despite advances in the treatment of HCC, including the development of tyrosine kinase inhibitors (TKIs). The outcomes of reduction hepatectomy and multidisciplinary postoperative treatment for advanced HCC that is not indicated for curative hepatectomy, including those of recently treated cases, should be investigated. AIM To examine the outcomes of combination treatment with reduction hepatectomy and multidisciplinary postoperative treatment for advanced HCC that is not indicated for curative hepatectomy. METHODS Thirty cases of advanced HCC that were not indicated for curative hepatectomy, in which reduction hepatectomy was performed between 2000 and 2018 at the Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, were divided into postoperative complete remission (POCR) (+) and POCR (-) groups, depending on whether POCR of all evaluable lesions was achieved through postoperative treatment. The cases in the POCR (-) group were subdivided into POCR (-) TKI (+) and POCR (-) TKI (-) groups, depending on whether TKIs were administered postoperatively. RESULTS The 5-year overall survival rate and mean survival time (MST) after reduction hepatectomy were 15.7% and 28.40 mo, respectively, for all cases; 37.5% and 56.55 mo, respectively, in the POCR (+) group; and 6.3% and 14.84 mo, respectively, in the POCR (-) group ( P = 0.0041). Tumor size, major vascular invasion, and the number of tumors in the remnant liver after the reduction hepatectomy were also found to be related to survival outcomes. The number of tumors in the remnant liver was the only factor that differed significantly between the POCR (+) and POCR (-) groups, and POCR was achieved significantly more frequently when ≤ 3 tumors remained in the remnant liver ( P = 0.0025). The MST was 33.52 mo in the POCR (-) TKI (+) group, which was superior to the MST of 10.74 mo seen in the POCR (-) TKI (-) group ( P = 0.0473). CONCLUSION Reduction hepatectomy combined with multidisciplinary postoperative treatment for unresectable advanced HCC that was not indicated for curative hepatectomy was effective when POCR was achieved via multidisciplinary postoperative therapy. To achieve POCR, reduction hepatectomy should aim to ensure that ≤ 3 tumors remain in the remnant liver. Even in cases in which POCR is not achieved, combined treatment with reduction hepatectomy and multidisciplinary therapy can improve survival outcomes when TKIs are administered.

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“…Outcomes of conversion surgery after intensive systemic therapy in patients with advanced HCC have increasingly been reported. (47)(48)(49)(50)(51)(52)(53)(54) Our group has recently reported the clinical outcomes of 107 consecutive patients who received treatment with lenvatinib for initially unresectable HCC (see Supplemental Table for details of baseline characteristics). After lenvatinib treatment for a median of 5.6 months, the overall response rate was 36.4% according to RECIST 1.1 and 63.6% according to the modified RECIST.…”

Section: Efficacy Of a New Molecular-targeted Agent In Allowing Conversion Surgery Among Patients With Advanced Hccmentioning

confidence: 99%

Multidisciplinary Approach to the Treatment of Advanced Hepatocellular Carcinoma in the Era of New Biologic Agents

Shindoh

2022

J Nippon Med Sch

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With the recent advances in the field of systemic therapy, an increasing number of patients with advanced hepatocellular carcinoma (HCC) are expected to benefit from surgery.However, given the complex background of the disease and frequent presence of underlying liver injury, treatment of advanced HCC is rather complex and the treatment principle applied to colorectal liver metastases, for which conversion surgery has been actively performed, is often not applicable to patients with HCC. To maximize the survival outcomes of patients with HCC, optimization of each step of treatment through a multidisciplinary approach is inevitable. As the initial treatment, systematic removal of the tumor-bearing portal territory is associated with improved survival in patients with solitary HCC, and radiofrequency ablation is also effective for small, oligo HCCs. Although the high incidence of recurrence even after curative-intent treatment is a major issue in HCC, aggressive treatment for recurrence is also important, because a prolonged cancer-free interval is reported to be associated with improved overall survival. For patients with advanced disease, recently introduced molecular-targeted agents may potentially be effective for successful conversion to surgery in initially unresectable cases, although the overall response rate of HCC to systemic therapies remains unsatisfactory as compared to that of colorectal liver metastases. In this report, the theoretical bases for the management of HCC are revisited and the currently used strategies to maximize the survival outcomes in patients with advanced HCC is discussed..

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Conversion hepatectomy for advanced hepatocellular carcinoma after right portal vein transection and lenvatinib therapy

Cited by 25 publications

References 20 publications

Two hepatectomy cases for initially unresectable hepatocellular carcinoma after achieving a radiological complete response to sequential therapy with lenvatinib and transcatheter arterial chemoembolization

Two hepatectomy cases for initially unresectable hepatocellular carcinoma after achieving a radiological complete response to sequential therapy with lenvatinib and transcatheter arterial chemoembolization

Outcomes of reduction hepatectomy combined with postoperative multidisciplinary therapy for advanced hepatocellular carcinoma

Multidisciplinary Approach to the Treatment of Advanced Hepatocellular Carcinoma in the Era of New Biologic Agents

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