Favorable radiological antitumor response at 2 weeks after starting lenvatinib for patients with advanced hepatocellular carcinoma

Abstract

Aim We aimed to investigate the radiological antitumor response at 2 weeks after starting lenvatinib for patients with advanced hepatocellular carcinoma in real‐world practice. Methods This retrospective study enrolled 40 patients who received lenvatinib. Radiological antitumor response was evaluated according to the modified Response Evaluation Criteria in Solid Tumors. Results The objective response rate at 2 weeks and best overall response on confirmation of complete response, partial response (PR), and stable disease required (confirmed response) were 57.5% and 32.5%, respectively. Based on confirmed response, the overall survival rate was significantly longer in patients with an objective response rate than in those with stable disease or progressive disease after 12 months (73.2% and 54.2%, P = 0.0358). All 13 patients with an objective response rate on confirmed response were evaluated as PR at 2 weeks. The alpha‐fetoprotein ratio at 2 weeks was a significant factor associated with PR of response rate at 2 weeks. The median relative dose intensity from 2 to 6 weeks was significantly lower than that from 0 to 2 weeks (69.6% vs. 100%, P < 0.0001). Stratified by the antitumor response at 6 weeks considering the image evaluation at 2 weeks, the median relative dose intensity from 2 to 6 weeks was significantly lower in patients with progressive disease than in those with PR or stable disease (45.2% vs. 72.6%, P = 0.0482). Conclusions The radiological antitumor response at 2 weeks was favorable. Information on a favorable visible therapeutic response very early after lenvatinib initiation can help patients maintain their motivation for treatment, and allow physicians to continue treatment effectively and safely.

Conversion therapy for unresectable hepatocellular carcinoma after lenvatinib

“…[ 8 – 10 ] It has also been reported that the relative dose intensity (RDI) plays an important role in the therapeutic effect of LEN. [ 8 , 11 , 12 ] In all of our cases, hepatic reserve function was good and the RDI, up to the first imaging evaluation, was high (Case 1: 75%, Case 2: 100%, Case 3: 100%) (Table 1 ). Although in BCLC stage B, cTACE/TAE is a standard treatment for unresectable HCC, Arizumi et al and Ogasawara et al reported that the switch from cTACE to SOR significantly improved the OS in patients with intermediate-stage HCC who were refractory to cTACE therapy.…”

Initial Experience of Ramucirumab Treatment After Lenvatinib Failure for Patients With Advanced Hepatocellular Carcinoma

“…Many investigators have reported that AFP reduction after systemic therapy, such as sorafenib and lenvatinib, was a useful prognostic marker of good outcomes (8,14). The REACH-2 trial was the first to show efficacy with a biomarker AFP level of ≥400 ng/ml, it documented that AFP level at baseline was a prognostic factor related to OS, but it did not document AFP response (1).…”

“…According to the clinical practice guidelines on the management of HCC (3,4), both sorafenib and lenvatinib were recommended as the first-line systemic therapy options for patients with advanced stage HCC. Because the REFLECT trial reported superior antitumor response and progression-free survival (PFS) with lenvatinib over sorafenib (5,6), lenvatinib has been increasingly selected as the first-line therapy in clinical practice (7)(8)(9)(10). However, the outcomes of ramucirumab treatment after lenvatinib failure are unknown, because the REACH-2 trial was conducted on patients with prior sorafenib intake (1).…”

Early Tumor Shrinkage as a Predictive Factor for Outcomes in Hepatocellular Carcinoma Patients Treated with Lenvatinib: A Multicenter Analysis

“…With LEN therapy, however, we have sometimes experienced that tumor growth occurs despite disappearance of arterial tumor enhancement, or that arterial tumor enhancement reappears soon after LEN interruption [28]. Kuzuya et al indicated that a good radiologic antitumor response, based on the mRECIST (i.e., almost complete disappearance of arterial tumor enhancement), might not necessarily imply tumor necrosis, especially soon after LEN initiation [29]. Thus, it is sometimes difficult to clearly distinguish between viable tumor tissue and necrotic tissue during the early phase of treatment.…”