A case of conversion hepatectomy for huge ruptured hepatocellular carcinoma after transarterial embolization and lenvatinib therapy

Naganuma, Akira; Suzuki, Yuhei; Hoshino, Takashi; Yasuoka, Hidetoshi; Tamura, Yukie; Naruse, Hiroaki; Tanaka, Hiroshi; Hirai, Keitaro; Sakamoto, Ichiro; Ogawa, Tetsushi; Hatanaka, Takeshi; Kakizaki, Satoru

doi:10.1007/s12328-021-01558-5

Cited by 8 publications

(4 citation statements)

References 31 publications

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“…reported that patients with good liver function have a higher likelihood of post‐progression therapy after lenvatinib, contributing to prolonged prognosis 13 . Recent reports have suggested that conversion therapy, such as surgery or radiofrequency ablation, is also effective after lenvatinib and should be considered as a treatment option, if possible 14–16 . Our study demonstrates the efficacy of ICIs for post‐progression therapy, providing support for their consideration as a treatment option in this setting.…”

Section: Discussionsupporting

confidence: 61%

“… 13 Recent reports have suggested that conversion therapy, such as surgery or radiofrequency ablation, is also effective after lenvatinib and should be considered as a treatment option, if possible. 14 , 15 , 16 Our study demonstrates the efficacy of ICIs for post‐progression therapy, providing support for their consideration as a treatment option in this setting. In this study, patients who used the ICI had fewer reliefs from side effects due to AEs in first‐line TKI treatment.…”

Section: Discussionmentioning

confidence: 61%

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Significance of post‐progression therapy after tyrosine kinase inhibitors for advanced hepatocellular carcinoma

Yano

Yamamoto

Minami³

et al. 2022

JGH Open

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Background and Aim: Molecular-targeted therapies such as sorafenib and lenvatinib have long been used as first-line treatment for advanced hepatocellular carcinoma (aHCC). However, adverse events or limited therapeutic effects may necessitate the change to another therapeutic option, known as post-progression therapy. To investigate the significance of post-progression therapy, we analyzed the outcomes of aHCC patients following first-line molecular-targeted therapy in a real-world study. Methods: This retrospective, multicenter study involved patients with aHCC who received sorafenib or lenvatinib as first-line therapy between January 2011 and September 2021. Results: In total, 513 patients were analyzed: 309 treated with sorafenib and 204 with lenvatinib. The overall response and disease control rates were 15 and 50%, respectively, in the sorafenib group and 30 and 75%, respectively, in the lenvatinib group (P < 0.001). Kaplan-Meier analysis revealed no significant differences in progressionfree survival and overall survival (OS) between the two treatments. Multivariate analysis revealed that fibrosis-4 index, disease control rate, post-progression therapy, and use of an immune checkpoint inhibitor (ICI) were significantly associated with OS. OS was significantly longer in patients who received post-progression therapy than in those who did not (log-rank P < 0.001). Most patients who received an ICI as post-progression therapy had previously received lenvatinib. Among lenvatinib-treated patients, OS was significantly longer in patients who received an ICI than in patients received another or no post-progression therapy (P = 0.004). Conclusion:The introduction of newer drugs for post-progression therapy is expected to prolong survival. ICI-based regimens appear to be effective after lenvatinib.

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Section: Discussionsupporting

confidence: 61%

Section: Discussionmentioning

confidence: 61%

Significance of post‐progression therapy after tyrosine kinase inhibitors for advanced hepatocellular carcinoma

Yano

Yamamoto

Minami³

et al. 2022

JGH Open

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“…Since the recent approval of LEN and Atezo + Bev, there have been a few case reports on successful cases of conversion therapy owing to their high response rates [15,26,27]. However, there have been few coherent reports, and no study has mentioned what kinds of cases can be converted during conversion therapy.…”

Section: Discussionmentioning

confidence: 99%

Clinical Features and Outcomes of Conversion Therapy in Patients with Unresectable Hepatocellular Carcinoma

Tomonari,

Tani,

Sato

et al. 2023

Cancers

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This retrospective multicenter study analyzed 244 patients with unresectable hepatocellular carcinoma treated with lenvatinib (LEN) and atezolizumab + bevacizumab (Atezo + Bev) to examine the characteristics, treatment courses, and prognoses. The cases of patients who could achieve HCC downstaging from Barcelona Clinic Liver Cancer (BCLC) stage B or C to A or zero indicated the need for conversion therapy. The patients’ prognoses with and without conversion therapy were compared. Of the 244 patients, 12 (4.9%) underwent conversion therapy, six out of 131 (4.6%) were treated with LEN, and six out of 113 (5.3%) were treated with Atezo + Bev. Eleven patients (91.7%) with a modified albumin bilirubin (mALBI) grade 1 or 2a and BCLC-B stage showed significantly higher rates of transition during conversion therapy (p < 0.05). The patients undergoing conversion therapy had a significantly longer median overall survival rate than those receiving chemotherapy alone (1208 [1064–NA] vs. 569 [466–704] days, p < 0.01). A comparison of the patients who achieved a partial response with and without conversion was evaluated using propensity score matching to reduce the confounding factors, showing a significant survival benefit in the conversion group (1208 [1064–NA] vs. 665 days, p < 0.01). Among the patients with u-HCC who were treated with LEN and Atezo + Bev, those with mALBI 1 + 2a and BCLC-B were likely to achieve conversion therapy with downstaging.

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“…There are several case reports of CS enabled by lenvatinib [ 4 – 7 ]. Among these cases, lenvatinib reportedly reduced the size of HCC with arterioportal shunt [ 4 ], HCC with preceding TACE treatment for its rupture [ 5 ], PVTT in the main trunk and contralateral branch [ 6 ], and intrahepatic recurrent HCC [ 7 ]. However, case reports on CS enabled by atezolizumab plus bevacizumab are limited [ 8 , 9 ].…”

Section: Discussionmentioning

confidence: 99%

Conversion surgery for hepatocellular carcinoma with portal vein tumor thrombus after successful atezolizumab plus bevacizumab therapy: a case report

et al. 2022

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Background The treatment of hepatocellular carcinoma (HCC) requires diverse and multidisciplinary approaches. In recent years, new agents with good antitumor effects have emerged for systemic chemotherapy, and conversion surgery (CS) after systemic chemotherapy is expected to be an effective treatment strategy for unresectable HCC. We herein report a case of unresectable HCC with portal vein tumor thrombus (PVTT) in which atezolizumab plus bevacizumab therapy induced PVTT regression, followed by CS with R0 resection. Case presentation The patient was a 79-year-old man with S2/S3 HCC who was referred to our department due to tumor re-growth and PVTT after two rounds of transcatheter arterial chemoembolization. The PVTT extended from the left portal vein to the main trunk, and it was determined that the resection of the left portal vein would be difficult to perform with R0 status. Based on the diagnosis of unresectable HCC, treatment with atezolizumab plus bevacizumab was initiated. After two courses of treatment, contrast-enhanced computed tomography showed that the PVTT had regressed to the peripheral side of the left portal vein, and R0 resection became possible. The patient developed grade 3 skin lesions as an immune-related adverse event, and it was determined that the continuation of chemotherapy would be difficult. Four weeks after the second course of atezolizumab plus bevacizumab administration, left lobectomy was performed. Intraoperative ultrasonography was used to confirm the location of the tumor thrombus in the left portal vein during the resection, and a sufficient surgical margin was obtained. The histopathological findings showed that primary tumor and PVTT were mostly necrotic with residues of viable tumor cells observed in some areas. The liver background was determined as A1/F4 (new Inuyama classification). The resection margins were negative, and R0 resection was confirmed. There were no postoperative complications. No recurrence was observed as of five months after surgery. Conclusions CS with atezolizumab plus bevacizumab therapy has potential utility for the treatment of unresectable HCC with PVTT.

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A case of conversion hepatectomy for huge ruptured hepatocellular carcinoma after transarterial embolization and lenvatinib therapy

Cited by 8 publications

References 31 publications

Significance of post‐progression therapy after tyrosine kinase inhibitors for advanced hepatocellular carcinoma

Significance of post‐progression therapy after tyrosine kinase inhibitors for advanced hepatocellular carcinoma

Clinical Features and Outcomes of Conversion Therapy in Patients with Unresectable Hepatocellular Carcinoma

Conversion surgery for hepatocellular carcinoma with portal vein tumor thrombus after successful atezolizumab plus bevacizumab therapy: a case report

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