Adaptation of lenvatinib treatment in patients with hepatocellular carcinoma and portal vein tumor thrombosis

Mukozu, Takanori; Nagai, Hidenari; Matsui, Daigo; Mohri, Kunihide; Watanabe, Go; Yoshimine, Naoyuki; Amaki, Makoto; Kobayashi, Kojiro F.; Ogino, Yu; Matsukiyo, Yasushi; Matsui, Teppei; Daido, Yasuko; Wakui, Noritaka; Shinohara, Mie; Momiyama, Koichi; Higai, Koji; Igarashi, Yoshinori

doi:10.1007/s00280-021-04359-2

Cited by 8 publications

(5 citation statements)

References 38 publications

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“…The lack of favorable responses in this study, when compared to previous studies, including the IMbrave150 trial and the REFLECT trials, can likely be attributed to the inclusion of only HCC patients with PVTT, a factor associated with an unfavorable prognosis. 8 - 10 , 13 , 26 Additionally, the higher proportion of patients with Child-Pugh score of six in our current study compared to the previous studies further contributes to the results. 27 Therefore, only stable disease or progressive disease was observed as the best treatment response.…”

Section: Discussionsupporting

confidence: 61%

Comparison of atezolizumab plus bevacizumab and lenvatinib for hepatocellular carcinoma with portal vein tumor thrombosis

Park,

Lee,

et al. 2024

JLC

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Background/Aim: Atezolizumab plus bevacizumab and lenvatinib are currently available as first-line therapy for the treatment of unresectable hepatocellular carcinoma (HCC). However, comparative efficacy studies are still limited. This study aimed to investigate the effectiveness of these treatments in HCC patients with portal vein tumor thrombosis (PVTT).Methods: We retrospectively included patients who received either atezolizumab plus bevacizumab or lenvatinib as first-line systemic therapy for HCC with PVTT. Primary endpoint was overall survival (OS), and secondary endpoints included progressionfree survival (PFS) and disease control rate (DCR) determined by response evaluation criteria in solid tumors, version 1.1.Results: A total of 52 patients were included: 30 received atezolizumab plus bevacizumab and 22 received lenvatinib. The median follow-up duration was 6.4 months (interquartile range, 3.9-9.8). The median OS was 10.8 months (95% confidence interval [CI], 5.7 to not estimated) with atezolizumab plus bevacizumab and 5.8 months (95% CI, 4.8 to not estimated) with lenvatinib (P=0.26 by log-rank test). There was no statistically significant difference in OS (adjusted hazard ratio [aHR], 0.71; 95% CI, 0.34-1.49; P=0.37). The median PFS was similar (P=0.63 by log-rank test), with 4.1 months (95% CI, 3.3-7.7) for atezolizumab plus bevacizumab and 4.3 months (95% CI, 2.6-5.8) for lenvatinib (aHR, 0.93; 95% CI, 0.51-1.69; P=0.80). HRs were similar after inverse probability treatment weighting. The DCRs were 23.3% and 18.2% in patients receiving atezolizumab plus bevacizumab and lenvatinib, respectively (P=0.74).Conclusion: The effectiveness of atezolizumab plus bevacizumab and lenvatinib was comparable for the treatment of HCC with PVTT.

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Section: Discussionsupporting

confidence: 61%

Comparison of atezolizumab plus bevacizumab and lenvatinib for hepatocellular carcinoma with portal vein tumor thrombosis

Park,

Lee,

et al. 2024

JLC

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“… 25 When lenvatinib monotherapy was used to treat HCC with Vp4, the median OS was only 121 days if the degree of occlusion of the portal trunk was ≥70%. 26 Moreover, a Phase II randomized trial found that the combination therapy group had a longer mOS (16.3 vs 6.5 months), mPFS (9.0 vs 2.5 months), and higher ORR (41% vs 3%) than the monotherapy group. 27 A multicenter retrospective study compared whether camrelizumab plus apatinib was effective and tolerable among HCC cases with PVTT.…”

Section: Discussionmentioning

confidence: 99%

Transarterial Chemoembolization Plus Lenvatinib and PD-1 Inhibitors for Hepatocellular Carcinoma with Main Trunk Portal Vein Tumor Thrombus: A Multicenter Retrospective Study

Li,

Wu,

et al. 2023

JHC

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Purpose In recent years, immune checkpoint inhibitors have been used in combination with tyrosine kinase inhibitors and local therapies, creating a new era in treating hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT). However, the benefits of this triple therapy remain unclear. Thus, this study evaluated whether the combination of transarterial chemoembolization (TACE), lenvatinib, and programmed death-1 (PD-1) inhibitors (triple therapy) was effective and safe for unresectable HCC with main trunk portal vein tumor thrombus (Vp4). Patients and Methods This study enrolled patients receiving triple therapy at four institutions between August 2018 and April 2022. Patient characteristics and course of treatment were extracted from patient records. Tumors and tumor thrombus response were evaluated using an HCC-specific modified RECIST. Kaplan–Meier curve analysis demonstrated overall survival (OS) and progression-free survival (PFS). Adverse events (AEs) were evaluated according to the National Cancer Institute Common Terminology Criteria for Adverse Events, version 5.0. Results Median follow-up duration was 18 (4.0–26.3) months. Overall, 41 patients with HCC and Vp4 receiving first-line triple therapy were enrolled. The intrahepatic tumor objective response rate was 68.3%. The median OS was 21.7 (range, 2.8–30.5) months, whereas the median PFS was 14.5 (range, 1.3–27.6) months. Twelve patients received sequential resections. Resection was independently associated with favorable OS and PFS. Fever (31.7%), hypertension (26.8%), fatigue (24.4%), abnormal liver function (63.4%) and decreased appetite (21.9%) were the AEs frequently associated with treatment. No treatment-related mortality occurred. Conclusion TACE plus lenvatinib and PD-1 inhibition was effective and tolerable for treating unresectable HCC with Vp4, with a high tumor response rate and favorable prognosis.

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“…The usefulness of lenvatinib for unresectable HCC with portal vein tumor thrombosis has been reported in recent years [6][7][8]; Chuma et al [9] reported favorable results in patients with Child-Pugh (CP) grade A unresectable HCC. In a recent study, they reported that the response rate to lenvatinib in patients with CP grade A unresectable HCC was significantly higher (26.7%) than in those with grade B unresectable HCC (0%).…”

Section: Discussionmentioning

confidence: 99%

A case of Vp4 hepatocellular carcinoma with tumor thrombosis extending into the confluence of the splenic/portal vein achieved a good prognosis with emergent hepatectomy and postoperative adjuvant therapy with lenvatinib

et al. 2022

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In this report, we describe a case of highly advanced hepatocellular carcinoma with tumor thrombosis extending into the main portal vein of the pancreas that was successfully treated with adjuvant lenvatinib after right hepatic resection with thrombectomy. A 70-year-old woman was referred from the clinic because of elevated hepatobiliary enzymes. The patient was positive for the hepatitis B virus antigen at our hospital. The tumor markers were highly elevated with alpha-fetoprotein (14.5 U/mL) and protein induced by vitamin K absence (PIVKAII) (1545 ng/mL), suggesting hepatocellular carcinoma. Dynamic abdominal computed tomography showed an early enhanced tumor approximately 6 cm in size and portal vein tumor thrombosis filling the main portal vein, but not extending into the splenic or superior mesenteric vein (SMV). On magnetic resonance imaging 1 week after CT, portal vein tumor thrombosis had extended to the confluence of the splenic vein with the SMV, indicating rapid tumor growth. Thus, we performed emergent right hepatectomy with tumor thrombectomy. Postoperatively, we treated the patient with lenvatinib for a tumor reduction surgery. Fortunately, the patient was alive 2 years postoperatively without recurrence. This case report suggests that a favorable outcome may be achieved with multidisciplinary treatment including resection and postoperative treatment with lenvatinib.

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Adaptation of lenvatinib treatment in patients with hepatocellular carcinoma and portal vein tumor thrombosis

Cited by 8 publications

References 38 publications

Comparison of atezolizumab plus bevacizumab and lenvatinib for hepatocellular carcinoma with portal vein tumor thrombosis

Comparison of atezolizumab plus bevacizumab and lenvatinib for hepatocellular carcinoma with portal vein tumor thrombosis

Transarterial Chemoembolization Plus Lenvatinib and PD-1 Inhibitors for Hepatocellular Carcinoma with Main Trunk Portal Vein Tumor Thrombus: A Multicenter Retrospective Study

A case of Vp4 hepatocellular carcinoma with tumor thrombosis extending into the confluence of the splenic/portal vein achieved a good prognosis with emergent hepatectomy and postoperative adjuvant therapy with lenvatinib

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