Efficacy and Safety of Lenvatinib-Transcatheter Arterial Chemoembolization Sequential Therapy for Patients with Intermediate-Stage Hepatocellular Carcinoma

Abstract

<b><i>Introduction:</i></b> We evaluated the efficacy and safety of lenvatinib-transcatheter arterial chemoembolization (LEN-TACE) sequential therapy for patients (<i>n</i> = 88) with intermediate-stage hepatocellular carcinoma (HCC). <b><i>Methods:</i></b> Eighty-eight patients who obtained tumor control by LEN treatment were analyzed; 30 received LEN followed by TACE (LEN-TACE sequential therapy), and 58 received LEN monotherapy. Propensity score matching was performed, and the outcomes of 19 patients in the LEN-TACE group and 19 patients in the LEN-alone group were compared. Objective response rate (ORR), progression-free survival (PFS), overall survival (OS), incidence of adverse events (AEs), and change in albumin-bilirubin (ALBI) score were evaluated. <b><i>Results:</i></b> After matching, baseline characteristics were similar between the groups. The ORR was 63.2% with LEN-TACE group and 63.2% with the LEN-alone group. Multivariate analysis showed that addition of TACE during LEN treatment (hazard ratio [HR] 0.264, 95% confidence interval [CI] 0.087–0.802, <i>p</i> = 0.019) and Child-Pugh score 5 (HR 0.223, 95% CI 0.070–0.704, <i>p</i> = 0.011) were the significant factors for PFS. Median PFS was 11.6 months with LEN-TACE and 10.1 months with LEN-alone. The survival rate of the LEN-TACE group was significantly higher than that of the LEN-alone group (median survival time; not reached vs. 16.9 months, <i>p</i> = 0.007). The incidence of common LEN-associated AEs was similar between groups. Although elevated aspartate aminotransferase/alanine aminotransferase and fever were more frequent with LEN-TACE group, these events were manageable. <b><i>Conclusion:</i></b> For patients with intermediate-stage HCC, LEN-TACE sequential therapy may provide a deep response and favorable prognosis.

Efficacy and Safety of Lenvatinib Combined With PD-1 Inhibitors Plus TACE for Unresectable Hepatocellular Carcinoma Patients in China Real-World

“…This might be the cause of the result. In addition, compared with other studies in the literature, the PFS of lenvatinib-TACE was 5.5 -11.6 months ( 30 – 32 ), while the PFS of our LePD1-TACE triple treatment achieved 10.4 months, our results were in the upper range. Notably, the different results between these studies and our data should be viewed with caution.…”

A prospective observational cohort study of lenvatinib as initial treatment in patients with BCLC-defined stage B hepatocellular carcinoma

“…The subgroup analysis presented here indicates that the Child–Pugh score is a critical factor for the prognosis of intermediate-stage HCC. Ando et al and Hiraoka et al also reported that the Child–Pugh score was critical for disease prognosis [ 27 , 28 ]. The high proportion (36%) of patients with a Child–Pugh score of 6, versus ~ 22% in REFLECT [ 29 ] and ~ 28% in IMbrave150 [ 30 ], may have led to the shorter median OS in the present study.…”

Transarterial Chemoembolization Combined With Tyrosine Kinase Inhibitors for Intermediate‐Stage Hepatocellular Carcinoma, What Else Can We Do?

“…Another study investigated lenvatinib-TACE sequential therapy versus lenvatinib alone in patients with intermediate-stage HCC who were not unsuitable for TACE. The results showed that the OS of the combined treatment group was significantly longer than that of the lenvatinib group (not reached vs. 16.9 months, p = 0.007) ( 105 ). Two studies suggest that early lenvatinib-TACE sequential therapy may be a good combination therapy for patients with intermediate-stage HCC who are not suitable for TACE.…”