Background: The aims of this study were to identify useful predictors of early tumor response to lenvatinib, and to evaluate the utility of estimation of tumor differentiation from pretreatment image analysis.
Methods: We evaluated 37 consecutive patients with unresectable hepatocellular carcinoma (HCC) diagnosed by dynamic computed tomography (CT) who received lenvatinib. Pretreatment arterial- and portal-phase dynamic CT images were classified into three enhancement patterns: Type-2 is a homogeneous enhancement pattern with increased arterial blood flow; Type-3 is a heterogeneous enhancement pattern with a septum-like structure; and Type-4 is a heterogeneous enhancement pattern with irregularly shaped ring structures. Generally, macroscopic classification of the nodular type of SNEG and CMN types strongly relates to the Type-3 enhancement pattern, and histologically, the Type-1 enhancement pattern represents well-differentiated HCC, while the Type-2 and -3 patterns represent moderately-differentiated HCC; the Type-4 enhancement pattern is a significantly specific feature for predicting poorly-differentiated HCC. Treatment response was evaluated using mRECIST at 8–12 weeks after initiation of lenvatinib.
Results: In early treatment response evaluation, 6 of 37 patients (16%) achieved a complete response (CR), 22 (59%) experienced a partial response (PR), 6 (16%) had stable disease (SD), and 3 (8%) had progressive disease (PD); therefore, 28 of 37 patients (76%) experienced an objective response (OR). By dynamic CT enhancement pattern using mRECIST, the objective response rate (ORR) was significantly elevated along with increasing heterogeneity of enhancement pattern from Type-2 (54%) to Type-4 pattern (89%; P=0.046). Multivariate logistic regression analysis revealed that a pretreatment dynamic CT heterogeneous enhancement pattern (Type-3 and -4) (hazard ratio, 6.12; P=0.040) is a useful predictor of early OR.
Conclusion: Lenvatinib provided a good early treatment response in patients with unresectable HCC. Estimation of tumor differentiation using image analysis was also useful for predicting early tumor response.
Front Cover Caption: The cover image is based on the Research Article Detection of TERT promoter mutation in serum cell‐free DNA using wild‐type blocking PCR combined with Sanger sequencing in hepatocellular carcinoma by Norio Akuta et al., https://doi.org/10.1002/jmv.25724.
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