Lenvatinib as first-line therapy for recurrent hepatocellular carcinoma after liver transplantation: Is the current evidence applicable to these patients?

Piñero, Federico; Thompson, Marcos; Marín, Juan Ignacio; Silva, Marcelo

doi:10.5500/wjt.v10.i11.297

Cited by 8 publications

(9 citation statements)

References 55 publications

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“…However, no prospective randomized controlled trial has focused on the efficacy and safety of sorafenib or lenvatinib; studies conducted for patients with recurrent HCC after LT remain scarce. To date, there have been several case series that demonstrated the effect and safety of sorafenib for recurrent HCC patients after LT [ 14 , 15 , 16 , 17 , 18 , 19 , 36 , 37 , 38 ]. The reported OS ranged from 5.4 months to 20.1 months; a highest disease control rate of 54% was mentioned in a Spanish study [ 36 , 37 , 38 ].…”

Section: Discussionmentioning

confidence: 99%

“…To date, there have been limited case reports regarding lenvatinib use in the post-LT setting. Pinero et al reported that a non-cirrhotic male patient with chronic HCV had tumor recurrence 5 years after LT, and then received lenvatinib at a dose of 12 mg/day for at least 16 months [ 15 ]. Our study showed 10 HCC patients with tumor recurrence after LT, in which all of these patients received sorafenib followed by lenvatinib.…”

Section: Discussionmentioning

confidence: 99%

“…However, HCC patients with recurrence after LT is a special group with small patient numbers. Even though sorafenib has been approved and used for more than 10 years in clinical practice, there were only a few studies published in the past, and the enrolled patient numbers were around 9 patients to 31 patients [ 15 ]. This situation indicates the limitation of this systemic therapy in HCC patients with liver transplantation.…”

Section: Discussionmentioning

confidence: 99%

“…The median duration of sorafenib ranged from 2.2 months to 10.2 months. Additionally, adverse events (AEs) included skin rash, hemifacial spasm, diarrhea, and fatigue; 92% of the patients experienced grade 3–4 diarrhea, and 77% discontinued sorafenib [ 14 , 15 , 16 , 17 , 18 , 19 ]. This may be related to many confounding factors: first, performance status after LT is an important issue, which depends on the complication of operation, side effects of immunosuppressants, and risk of opportunistic infections; second, previous studies have demonstrated that the period early after LT is associated with poor prognosis, indicating that a shorter recurrence time may reduce the effect of sorafenib; other prognostic variables were reported, such as the tumor location, serum alpha-fetoprotein (AFP) level, sites of distant metastasis, and number of organ involvement [ 8 , 20 , 21 ].…”

Section: Introductionmentioning

confidence: 99%

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Efficacy and Safety of Lenvatinib in Hepatocellular Carcinoma Patients with Liver Transplantation: A Case-Control Study

Chen

Lin

et al. 2021

Cancers

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Tumor recurrence is the most common cause of death in hepatocellular carcinoma (HCC) patients who received liver transplantation (LT). Recently, lenvatinib was approved for the systemic treatment of unresectable HCC patients; however, the role of lenvatinib in HCC patients after LT remains unclear. There were 56 patients with recurrent HCC after LT from 2008 to 2018 in our institute, and 10 patients who received lenvatinib were identified. Additionally, to understand the difference in the clinical impact of lenvatinib in the LT and non-LT settings, 25 HCC patients without LT who underwent lenvatinib treatment were identified from our HCC database and regarded as the control group. In the LT group, partial response was 20% and stable disease was 50%, resulting in a disease control rate of 70%; the median progression-free survival (PFS), time to treatment failure (TTF) and overall survival (OS) were 3.7, 3.6 and 16.4 months, respectively. Adverse events (AEs) were predominantly grade 1–2 in severity, and the majority of patients tolerated the side effects. There was no significant difference in PFS/OS, and we observed a similar pattern of AEs between these two groups. Our study confirms the comparable efficacy and safety of lenvatinib in HCC patients with LT and non-LT in clinical practice.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Efficacy and Safety of Lenvatinib in Hepatocellular Carcinoma Patients with Liver Transplantation: A Case-Control Study

Chen

Lin

et al. 2021

Cancers

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“…Lenvatinib is a tyrosine kinase inhibitor which blocks VEGF as well as fibroblast growth factor (FGF) and platelet derived growth factor (PDGF) pathways. In the non-LT population, a phase 3 randomised control trial (REFLECT trial) showed non-inferior survival with lenvatinib vs. sorafenib (13.6 months vs. 12.3 months) [110][111][112] . The adverse event profile was, however, more severe in the lenvatinib arm.…”

Section: Targeted Therapymentioning

confidence: 99%

Risk factors and management of post-liver transplant recurrence of hepatocellular carcinoma

Rammohan¹,

Rela²

2021

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Hepatocellular carcinoma (HCC) is one of the most common indications for liver transplantation (LT). With expanding criteria and increasing number of transplants, post-transplant recurrence of HCC remains an important cause for concern and portends a poor survival in these patients. Traditionally, HCC recurrence post-LT has been notoriously difficult to manage and their outcomes dismal. A better understanding of the tumour biology and its interplay with the immune system, combined with newer oncological interventions has allowed for improved survivals in these patients. A useful classification of HCC recurrence is where it is divided into oligo-recurrence and disseminated recurrence. This system helps strategize their multi-disciplinary management algorithm and prognosticate outcomes. We provide an overview of the factors which may predict recurrence and summarise the current evidence on the management of post-LT HCC recurrence.

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Efficacy and safety of lenvatinib in patients with recurrent hepatocellular carcinoma after liver transplantation

et al. 2022

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Background: Lenvatinib is approved for patients with metastatic or recurrent hepatocellular carcinoma (HCC); however, its clinical outcomes in patients experiencing HCC recurrence after liver transplantation (LT) remain unclear. Thus, we investigated the e cacy and safety of lenvatinib in patients with recurrent HCC after LT. Methods: This multinational, multicenter, retrospective study included 45 patients with recurrent HCC after LT who received lenvatinib at six institutions in three countries (Korea, Italy, and Hong Kong) from June 2017 to October 2021.Results: At the time of lenvatinib initiation, 95.6% (n = 43) of patients were Child-Pugh A, with 35 (77.8%) and 10 (22.2%) patients classi ed as albumin-bilirubin (ALBI) grades 1 and 2, respectively. The objective response rate was 20.0%. With a median follow-up duration of 12.9 months (95% con dence interval [CI]: 11.2-14.7), median progression-free survival and overall survival (OS) were 7.6 (95% CI: 5.3-9.8) months, and 14.5 (95% CI: 0.8-28.2) months, respectively. Patients with ALBI grade 1 showed signi cantly better OS (52.3 months, [95% CI: not assessable]) than patients with ALBI grade 2 (11.1 months [95% CI: 0.0-30.4 months], p = 0.003). The most common adverse events were hypertension (n = 25, 55.6%), fatigue (n = 17, 37.8%), and anorexia (n = 14, 31.1%).Conclusion: Lenvatinib showed consistent e cacy and toxicity pro les in patients with recurrent HCC after LT compared to the results of previous studies of non-LT HCC patients. The baseline ALBI grade was correlated with better OS in lenvatinib-treated patients with LT.

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Lenvatinib as first-line therapy for recurrent hepatocellular carcinoma after liver transplantation: Is the current evidence applicable to these patients?

Cited by 8 publications

References 55 publications

Efficacy and Safety of Lenvatinib in Hepatocellular Carcinoma Patients with Liver Transplantation: A Case-Control Study

Efficacy and Safety of Lenvatinib in Hepatocellular Carcinoma Patients with Liver Transplantation: A Case-Control Study

Risk factors and management of post-liver transplant recurrence of hepatocellular carcinoma

Efficacy and safety of lenvatinib in patients with recurrent hepatocellular carcinoma after liver transplantation

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