Nutritional Index as Prognostic Indicator in Patients Receiving Lenvatinib Treatment for Unresectable Hepatocellular Carcinoma

Hiraoka, Atsushi; Kumada, Takashi; Tada, Toshifumi; Fukunishi, Shinya; Atsukawa, Masanori; Hirooka, Masashi; Tsuji, Kiichiro; Ishikawa, Toru; Takaguchi, Koichi; Kariyama, Kazuya; Itobayashi, Ei; Tajiri, Kazuto; Shimada, Noritomo; Shibata, Hiroshi; Ochi, Hironori; Kawata, Kazuhito; Toyoda, Hidenori; Ohama, Hideko; Tsutsui, Akemi; Itokawa, Norio; Hayama, Korenobu; Arai, Taeang; Imai, Michitaka; Nakamura, Shinichiro; Michitaka, Kojiro; Hiasa, Yoichi; Kudo, Masatoshi

doi:10.1159/000506293

Cited by 27 publications

(33 citation statements)

References 30 publications

(40 reference statements)

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“…These reports indicate that BTR is not only a crucial nutritional indicator, but also a prognostic factor for patients with HCC. Similar to our findings, Hiraoka et al 17 recently reported the importance of pre‐treatment nutritional status in lenvatinib treatment using Onodera's prognostic nutritional index. As shown in AE profile (Table 2), treatment with lenvatinib was associated with a higher risk for worsening of nutritional status, which could lead to the dose reduction or treatment discontinuation.…”

Section: Discussionsupporting

confidence: 92%

Branched‐chain amino acid to tyrosine ratio is an essential pre‐treatment factor for maintaining sufficient treatment intensity of lenvatinib in patients with hepatocellular carcinoma

Eso

Nakano

Mishima

et al. 2020

J Hepato Biliary Pancreat

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More than 500 000 cases of hepatocellular carcinoma (HCC) are diagnosed every year; and HCC is one of the leading causes of cancer-related deaths worldwide. 1 For patients with early-stage HCC, either surgical resection or ablation are offered. 2 However, the treatment options for unresectable advanced-stage HCC are limited, and the prognosis is still poor because of the high potential for intra-and extra-hepatic recurrence. An oral tyrosine kinase inhibitor sorafenib was approved in 2007 as the first

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Section: Discussionsupporting

confidence: 92%

Branched‐chain amino acid to tyrosine ratio is an essential pre‐treatment factor for maintaining sufficient treatment intensity of lenvatinib in patients with hepatocellular carcinoma

Eso

Nakano

Mishima

et al. 2020

J Hepato Biliary Pancreat

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“…Some studies have reported that the PNI is a prognostic factor in HCC patients receiving surgical treatment [97,98] or sorafenib treatment [99,100]. The PNI was strongly correlated with the ALBI score and the predictive cut-off values of the PNI for ALBI grade 1 and mALBI grade 2a were 39.0 and 36.0, respectively [101]. Based on these studies, the nutrition status is considered to impact the prognosis in advanced HCC patients who are treated with lenvatinib.…”

Section: Nutrition Assessment As a Prognostic Indicatormentioning

confidence: 99%

Lenvatinib for Hepatocellular Carcinoma: A Literature Review

2021

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Lenvatinib, which is an oral multikinase inhibitor, showed non-inferiority to the sorafenib in terms of overall survival (OS) and a higher objective response rate (ORR) and better progression-free survival (PFS) in patients with hepatocellular carcinoma (HCC). A good liver function and Barcelona Clinic Liver Cancer (BCLC) intermediate stage were the key factors in achieving therapeutic efficacy. The management of adverse events plays an important role in continuing lenvatinib treatment. While sequential therapies contributed to prolonging overall survival, effective molecular targeted agents for the administration after lenvatinib have not been established. Repeated transcatheter arterial chemoembolization (TACE) was associated with a decline in the liver function and poor therapeutic response in BCLC intermediate patients. Recently, the Asia-Pacific Primary Liver Cancer Expert (APPLE) Consensus Statement proposed the criteria for TACE unsuitability. Upfront systemic therapy may be better for the BCLC intermediate stage HCC patients with a high tumor burden, while selective TACE will be recommended for obtaining a curative response in patients with a low tumor burden. This article reviews the therapeutic response, management of adverse events, post-progression treatment after Lenvatinib, and treatment strategy for BCLC intermediate stage HCC.

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“…On the other hand, only a few studies explored possible prognostic factors in patients treated with lenvatinib. [13][14][15] To fill this gap, the aim of the present study was to evaluate a new prognostic index through a statistical method for analysis of multiple variables, named recursive partitioning analysis (RPA), that creates a regression-treebased on prognostic value. 16…”

Section: Introductionmentioning

confidence: 99%

Identification of lenvatinib prognostic index via recursive partitioning analysis in advanced hepatocellular carcinoma

et al. 2021

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Background: After the advent of new treatment options for advanced hepatocellular carcinoma (HCC), the identification of prognostic factors is crucial for the selection of the most appropriate therapy for each patient. Patients and methods: With the aim to fill this gap, we applied recursive partitioning analysis (RPA) to a cohort of 404 patients treated with lenvatinib. Results: The application of RPA resulted in a classification based on five variables that originated a new prognostic score, the lenvatinib prognostic index (LEP) index, identifying three groups: low risk [patients with prognostic nutritional index (PNI) >43.3 and previous trans-arterial chemoembolization (TACE)]; medium risk [patients with PNI >43.3 but without previous TACE and patients with PNI <43.3, albumin-bilirubin (ALBI) grade 1 and Barcelona Clinic Liver Cancer stage B (BCLC-B)]; high risk [patients with PNI <43.3 and ALBI grade 2 and patients with PNI <43.3, albumin-bilirubin (ALBI) grade 1 and Barcelona Clinic Liver Cancer stage C (BCLC-C)]. Median overall survival was 29.8 months [95% confidence interval (CI) 22.8-29.8 months] in low risk patients (n ¼ 128), 17.0 months (95% CI 15.0-24.0 months) in medium risk (n ¼ 162) and 8.9 months (95% CI 8.0-10.7 months) in high risk (n ¼ 114); low risk hazard ratio (HR) 1 (reference group), medium risk HR 1.95 (95% CI 1.38-2.74), high risk HR 4.84 (95% CI 3.16-7.43); P < 0.0001. The LEP index was validated in a cohort of 127 Italian patients treated with lenvatinib. While the same classification did not show a prognostic value in a cohort of 311 patients treated with sorafenib, we also show a possible predictive role in favor of lenvatinib in the low risk group. Conclusions: LEP index is a promising, easy-to-use tool that may be used to stratify patients undergoing systemic treatment of advanced HCC.

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Nutritional Index as Prognostic Indicator in Patients Receiving Lenvatinib Treatment for Unresectable Hepatocellular Carcinoma

Cited by 27 publications

References 30 publications

Branched‐chain amino acid to tyrosine ratio is an essential pre‐treatment factor for maintaining sufficient treatment intensity of lenvatinib in patients with hepatocellular carcinoma

Branched‐chain amino acid to tyrosine ratio is an essential pre‐treatment factor for maintaining sufficient treatment intensity of lenvatinib in patients with hepatocellular carcinoma

Lenvatinib for Hepatocellular Carcinoma: A Literature Review

Identification of lenvatinib prognostic index via recursive partitioning analysis in advanced hepatocellular carcinoma

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