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

Abstract

We investigated the association between early tumor shrinkage (ETS) and treatment outcome in patients with hepatocellular carcinoma treated with lenvatinib (LEN). A retrospective analysis was performed in 104 patients. ETS was defined as tumor shrinkage at the first evaluation in the sum of target lesions’ longest diameters from baseline according to the Response Evaluation Criteria in Solid Tumors (RECIST). The median overall survival (OS) was not reached, whereas the median progression-free survival (PFS) was 5.0 months. The receiver operating characteristic curve analysis in differentiating long-term responders (PFS ≥ 5.0 months) from short-term responders (PFS < 5.0 months) revealed an ETS cut-off value of 10%. ETS ≥ 10% was significantly correlated with better PFS and OS compared with ETS < 10%. Additionally, ETS ≥ 10% showed a better discrimination ability on prognosis compared with modified RECIST-based objective response at the first evaluation. Multivariate analysis confirmed ETS ≥ 10% as an independent predictor of better OS, as well as a Child–Pugh score of 5 and macrovascular invasion. In conclusion, ETS ≥ 10% was strongly associated with outcome in patients treated with LEN. This biomarker could allow earlier assessment of the treatment response and guide treatment decision-making for HCC.

What Can Be Done to Solve the Unmet Clinical Need of Hepatocellular Carcinoma Patients following Lenvatinib Failure?

“…Since introduction of REG as second-line treatment for SOR, it has been reported that MTA sequential treatment has a greater contribution to improving prognosis as compared to single MTA line treatment [34]. LEN was recently developed as a first-line MTA drug [5], though it also serves as a second-and even third-line treatment option in Japan [7,[35][36][37][38][39]. We previously reported that the total MTA administration period including LEN treatment had a good correlation with OS after introduction of the initial MTA drug (SOR in 95.2% of those patients) (r = 0.946, 95% CI: 0.918-0.965, p < 0.001), with a median OS after that in- [40].…”

Early tumor shrinkage and response assessment according to mRECIST predict overall survival in hepatocellular carcinoma patients under sorafenib

“…In clinical practice, early identification of patients benefitting from sorafenib treatment is crucial to avoid overtreatment, which may lead to toxicities or suboptimal treatment sequencing, especially in light of alternative treatments [ 13 – 15 ]. Early tumor shrinkage (ETS) is defined as a reduction in tumor size at the first radiological follow-up evaluation and it has been shown to predict treatment outcome in patients with metastatic colorectal carcinoma, pancreatic cancer, renal cell carcinoma, and also in patients with HCC receiving lenvatinib treatment [ 16 – 19 ].…”

SnoRD126 promotes the proliferation of hepatocellular carcinoma cells through transcriptional regulation of FGFR2 activation in combination with hnRNPK

“…Liver cancer is the sixth most common malignancy and the fourth leading cause of cancer-related death worldwide [ 1 ]. Hepatocellular carcinoma (HCC) is the primary type of liver cancer, accounting for 75-85% of all liver cancer cases.…”