Lenvatinib with or without Stereotactic Body Radiotherapy for Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis: a retrospective study

Abstract

Background and objectives: Patients with hepatocellular carcinoma (HCC) involving portal vein tumor thrombosis (PVTT) are presently lacking effective treatment options. We aimed to compare the efficacy and safety of lenvatinib with or without SBRT for HCC with PVTT. Materials and Methods: This retrospective analysis included 37 patients treated with lenvatinib in combination with SBRT and 77 patients treated with lenvatinib alone from August 2018 to August 2021. Overall survival (OS), progression-free survival (PFS), intrahepatic PFS (IHPFS) and objective remission rate (ORR) were compared between the two groups, while adverse events (AEs) was analyzed between the two groups to assess safety profiles. Results: Median OS, PFS and IHPFS were significantly prolonged in the combination treatment group compared with the single treatment group (median OS, 19.3 vs. 11.2 months, p < 0.001; median PFS: 10.3 vs. 5.3 months, p < 0.001; median IHPFS, 10.7 vs. 5.3 months, p < 0.001). Moreover, a higher ORR (56.8% vs. 20.8%, P < 0.001) were observed in the lenvatinib combined with SBRT group. In subgroup analyses of Vp1-2 and Vp3-4 group, median OS, PFS and IHPFS were also significantly longer in the lenvatinib combined with SBRT group than those in the lenvatinib alone group. AEs in the combined therapy group were mostly manageable and the incidence was not statistically significant compared to the monotherapy group. Conclusion: Lenvatinib plus SBRT had a significantly better survival benefit than lenvatinib monotherapy in the treatment of HCC patients with PVTT and was well tolerated.

The Role of Targeted Radiation Therapy in the Treatment of Renal Cell Carcinoma

“…Therapies that target the VEGF receptor such as axitinib are generally thought to be safe in combination with SBRT [22], though caution should be taken when treating near bowel as one study suggested increased toxicity for the multikinase inhibitors that target VEGF [23]. Generally, away from the bowel, tyrosine kinase inhibitors are cautiously considered safe with SBRT [24], including cabozantinib [25], sunitinib [5], pazopanib [26], sorafenib [27] and Lenvatinib [28]. Immune targeted agents such as IL-2 [29], pembrolizumab and ipilimumab [30] are also generally thought to be safe in combination with SBRT for renal cell carcinoma [31,32], though there is some suggestion that the combination of immunotherapy with intracranial radiosurgery for brain metastases may increase treatment related inflammatory changes [33].…”