Conversion therapy for unresectable hepatocellular carcinoma after lenvatinib

Abstract

Introduction: Lenvatinib (LEN) is a novel potent multi-tyrosine kinase inhibitor, approved as first-line treatment for unresectable hepatocellular carcinoma (HCC). Considering its high objective response rate, LEN therapy could be expected to achieve downstaging of tumors and lead to conversion therapy with hepatectomy or ablation. However, the feasibility of conversion therapy after LEN treatment in unresectable HCC remains largely unknown. Patient concerns: Here, we reported 3 cases of unresectable HCC: case 1, a 69-year-old man diagnosed with ruptured HCC; case 2, a 72-year-old woman with nonalcoholic steatohepatitis-based HCC; and case 3, a 73-year-old man with a history of alcoholic cirrhosis-based HCC. Diagnosis: In all cases, cirrhosis was classified as Child-Pugh 5 and modified albumin-bilirubin grade 1 or 2a. HCC was diagnosed as Barcelona Clinic Liver Cancer (BCLC) stage B. Interventions: In all cases, LEN was initiated after conventional-transcatheter arterial embolization enforcement, while maintaining liver function. Outcomes: In all cases, the main tumor size decreased after 6 months of LEN treatment and no satellite nodes were detected, indicating downstaging of HCC to BCLC stage A. Subsequently, conversion hepatectomy or ablation was performed. After successful conversion therapy, the general condition of the patients was good, without tumor recurrence during the observation period (median 10 months). Lessons: This study demonstrated that LEN enables downstaging of HCC and thus represents a bridge to successful surgery or ablation therapy. In particular, LEN treatment may facilitate the possibility for conversion therapy of initially unresectable HCC, while maintaining the hepatic functional reserve.

Comparison of therapeutic outcomes of sorafenib and lenvatinib as primary treatments for hepatocellular carcinoma with a focus on molecular‐targeted agent sequential therapy: A propensity score‐matched analysis

“…Considering the selection of first‐line MTAs for u‐HCC, LEN might be preferable to SOR when tumor shrinkage is needed for controlling intrahepatic tumors, which are at a high risk of rupture or macrovascular invasion 26 . Moreover, LEN is expected to show a high possibility of downstaging u‐HCC with a high tumor burden, resulting in a switch to locoregional therapies such as conversion hepatectomy 27–29 . However, more studies are needed for investigating the therapeutic efficacy of conversion therapy using LEN.…”

“…26 Moreover, LEN is expected to show a high possibility of downstaging u-HCC with a high tumor burden, resulting in a switch to locoregional therapies such as conversion hepatectomy. [27][28][29] However, more studies are needed for investigating the therapeutic efficacy of conversion therapy using LEN.…”

Development of a preoperative prognostic scoring system to predict benefits of hepatic resection in advanced hepatocellular carcinoma patients

“…Surgical treatment for high-risk patients needs to be carefully considered, and the prognosis of patients undergoing surgical treatment is worse than that of patients with systematic treatment [41]. At present, after conversion therapy is effective, surgical treatment has also achieved a good prognosis, but more researches are needed to determine whether this treatment regimen will benefit all high-risk patients [42].…”

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

“…There are some reports about conversion hepatectomy for advanced hepatocellular carcinoma after lenvatinib therapy [ 10 – 16 ]. Sato et al and Tomonari et al reported conversion hepatectomy for HCC after transarterial chemoembolization (TACE) and lenvatinib therapy [ 10 , 11 ]. Matsuki et al reported a complete pathological response in conversion hepatectomy from lenvatinib treatment for advanced hepatocellular carcinoma [ 12 ].…”