Management of hepatocellular carcinoma patients with portal vein tumor thrombosis: A narrative review

Tao, Ziwen; Cheng, Baoquan; Gao, Yanjing; ZW, Tao; BQ, Cheng; Zhou, Tao; Yj, Gao

doi:10.1016/j.hbpd.2021.12.004

Cited by 38 publications

(30 citation statements)

References 96 publications

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“…The previously reported prognosis of patients with major PVTT-HCC treated with sorafenib was 6.5 months [23]. The prognosis for other 1 st line systemic treatments, such as lenvatinib and atezolizumab plus bevacizumab combination therapy, is also approximately six months [7,24]. In the SILIUS trial, a randomized clinical trial comparing the efficacy of sorafenib and sorafenib plus low-dose FP in the treatment of HCC, additional low-dose FP showed a statistically significant effect for major PVTT-HCC as compared with sorafenib [25]; these researchers also reported that objective response could be an independent prognostic factor for OS [26].…”

Section: Discussionmentioning

confidence: 99%

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Hepatic Arterial Infusion Chemotherapy New-FP for Hepatocellular Carcinoma with Major Portal Vein Tumor Thrombus

Iwamoto

Niizeki

Nagamatsu

et al. 2022

Preprint

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Background/Purpose: Although macrovascular invasion (MVI), particularly major portal vein tumor thrombus (PVTT), is a critical tumor condition in hepatocellular carcinoma (HCC), determining the optimal treatment is an unmet medical need. We aimed to compare the efficacy of hepatic arterial infusion chemotherapy (HAIC) regimens New-FP (fine-powder cisplatin/ lipiodol suspension and 5-fluorouracil) and sorafenib for MVI-HCC and major PVTT-HCC in patients with preserved liver function. Methods: We retrospectively analyzed 1,709 consecutively presenting patients with HCC who were initially treated with New-FP or sorafenib (March 2009 to June 2019). Overall survival and prognostic factors were assessed in both groups after propensity score matching (n=198 each). Subgroup analyses were conducted in four groups: cohort 1 (no MVI or extrahepatic spread [EHS]), cohort 2 (MVI only), cohort 3 (EHS only), and cohort 4 (MVI and EHS). Cohort 5 evaluated major PVTT (including EHS). Results: The New-FP group had a longer median survival time (MST) than the sorafenib group (New-FP, 18 months; sorafenib, nine months; p<0.0001). New-FP demonstrated a statistically longer MST compared with sorafenib in cohorts 2 and 4. In cohort 5, the MST of the New-FP group was 16 months, while that of sorafenib was six months (p<0.0001). For major PVTT-HCC, the objective response rate for New-FP was 73.0%. The MST of patients who achieved a complete response with New-FP (16.6%) was 59 months. Conclusion: New-FP showed significant efficacy for MVI-HCC, including major PVTT-HCC. Even in the era of systemic treatment, HAIC using New-FP is a promising modality for patients with advanced HCC.

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Section: Discussionmentioning

confidence: 99%

“…Locoregional treatments have traditionally been administered in the treatment of HCC. Hepatic arterial infusion chemotherapy (HAIC) is a frequently administered treatment for advanced HCC [7,8]. HAIC directly and consecutively delivers chemotherapeutic drugs to the tumor using catheter techniques.…”

Section: Introductionmentioning

confidence: 99%

Hepatic Arterial Infusion Chemotherapy New-FP for Hepatocellular Carcinoma with Major Portal Vein Tumor Thrombus

Iwamoto

Niizeki

Nagamatsu

et al. 2022

Preprint

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“…In our COX regression model, it was also demonstrated that the classi cation of PVTT was an independent factor affecting OS (P < 0.001). The classi cation of PVTT is closely related to the prognosis of HCC, and there are differences in survival outcomes with different treatments for different classi cation of PVTT [30]. Xi et al [31] found that SBRT treatment for HCC with portal vein and/or inferior vena cava tumor thrombosis exhibited good local control rates with low toxicity.…”

Section: Discussionmentioning

confidence: 99%

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

Sun

et al. 2023

Preprint

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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.

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“…The treatment of HCC with RA tumor thrombus via progression through the hepatic veins into the IVC is challenging ( 18 ). Treatment with sorafenib and best supportive care ( 20 ) as well as pembrolizumab plus lenvatinib treatment has been recommended ( 21 ). However, the prognosis of RA tumor thrombi is poor, and the identification of safe and effective local therapies is required.…”

Section: Discussionmentioning

confidence: 99%

Case Report: Radiotherapy Plus Immunotherapy and Lenvatinib for the Treatment of Recurrent Hepatocellular Carcinoma With a Right Atrium and Inferior Vena Cava Tumor Thrombus

Qian

Gong

et al. 2022

Front. Oncol.

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BackgroundThe treatment of hepatocellular carcinoma (HCC) with right atrium (RA) and inferior vena cava (IVC) tumor thrombi is challenging, with the standard treatment being not well established. Immunotherapy plus antiangiogenic therapy is a potentially effective treatment for patients with advanced HCC. Here, we described the case of a patient with HCC with RA and IVC tumor thrombi who achieved a successful response from radiotherapy and targeted therapy plus immunotherapy.Case SummaryA 62-year-old women presented with severe bilateral lower extremity edema identified as recurrent HCC with RA and IVC tumor thrombi based on past medical history and computed tomography. The patient received palliative radiotherapy plus pembrolizumab and lenvatinib treatment and was relieved of disease symptoms of bilateral lower extremity edema. The HCC with RA and IVC tumor thrombi shrunk, and the progression-free survival of this patient was > seven months.ConclusionTumor thrombus-directed radiotherapy plus concurrent immunotherapy and targeted therapy might be a feasible and safe approach for patients with HCC with RA and IVC tumor thrombi.

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Management of hepatocellular carcinoma patients with portal vein tumor thrombosis: A narrative review

Cited by 38 publications

References 96 publications

Hepatic Arterial Infusion Chemotherapy New-FP for Hepatocellular Carcinoma with Major Portal Vein Tumor Thrombus

Hepatic Arterial Infusion Chemotherapy New-FP for Hepatocellular Carcinoma with Major Portal Vein Tumor Thrombus

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

Case Report: Radiotherapy Plus Immunotherapy and Lenvatinib for the Treatment of Recurrent Hepatocellular Carcinoma With a Right Atrium and Inferior Vena Cava Tumor Thrombus

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