Lenvatinib as an Initial Treatment in Patients with Intermediate-Stage Hepatocellular Carcinoma Beyond Up-To-Seven Criteria and Child–Pugh A Liver Function: A Proof-Of-Concept Study
Masatoshi Kudo,Kazuomi Ueshima,S.L. Chan,Tomohiro Minami,Hirokazu Chishina,Tomoko Aoki,Masahiro Takita,Satoru Hagiwara,Yasunori Minami,Hiroshi Ida,Mamoru Takenaka,Toshiharu Sakurai,Tomohiro Watanabe,Masahiro Morita,Chikara Ogawa,Yoshiyuki Wada,Masafumi Ikeda,Hiroshi Ishii,Namiki Izumi,Naoshi Nishida +19 more
TLDR
In patients with large or multinodular intermediate-stage HCC exceeding the up-to-seven criteria with Child–Pugh A liver function, lenvatinib provides a more favorable outcome than TACE.Abstract:
Although transcatheter arterial chemoembolization (TACE) is the standard of care for intermediate-stage hepatocellular carcinoma (HCC), this is a largely heterogeneous disease that includes a subgroup of patients who do not benefit from TACE. The treatment strategy for this subgroup of patients currently remains an unmet need in clinical practice. Here, we performed a proof-of-concept study that lenvatinib may be a more favorable treatment option over TACE as an initial treatment in intermediate-stage HCC patients with large or multinodular tumours exceeding the up-to-seven criteria. This proof-of-concept study included 642 consecutive patients with HCC initially treated with lenvatinib or conventional TACE (cTACE) between January 2006 and December 2018. Of these patients, 176 who received lenvatinib or cTACE as an initial treatment and met the eligibility criteria (unresectable, beyond the up-to-seven criteria, no prior TACE/systemic therapy, no vascular invasion, no extrahepatic spread and Child–Pugh A liver function) were selected for the study. Propensity score matching was used to adjust for patient demographics. After propensity-score matching, the outcome of 30 patients prospectively treated with lenvatinib (14 in clinical trials, one in an early access program and 15 in real world settings) and 60 patients treated with cTACE as the initial treatment was compared. The change of albumin-bilirubin (ALBI) score from baseline to the end of treatment were −2.61 to −2.61 for 30 patients in the lenvatinib group (p = 0.254) and −2.66 to −2.09 in the cTACE group (p < 0.01), respectively. The lenvatinib group showed a significantly higher objective response rate (73.3% vs. 33.3%; p < 0.001) and significantly longer median progression-free survival than the cTACE group (16.0 vs. 3.0 months; p < 0.001). Overall survival was significantly longer in the lenvatinib group than in the cTACE group (37.9 vs. 21.3 months; hazard ratio: 0.48, p < 0.01). In patients with large or multinodular intermediate-stage HCC exceeding the up-to-seven criteria with Child–Pugh A liver function, who usually do not benefit from TACE, lenvatinib provides a more favorable outcome than TACE.read more
Citations
More filters
Journal ArticleDOI
Targeted therapy for hepatocellular carcinoma.
TL;DR: Combination therapies, including anti-angiogenesis agents with ICIs, dual ICIs and targeted agents in conjunction with surgery or other loco-regional therapies, have shown promise and provided the basis for exciting clinical trials.
Journal ArticleDOI
Management of Hepatocellular Carcinoma in Japan: JSH Consensus Statements and Recommendations 2021 Update.
Masatoshi Kudo,Yusuke Kawamura,Kiyoshi Hasegawa,Ryosuke Tateishi,Kazuya Kariyama,Shuichiro Shiina,Hidenori Toyoda,Yasuharu Imai,Atsushi Hiraoka,Masafumi Ikeda,Namiki Izumi,Michihisa Moriguchi,Sadahisa Ogasawara,Yasunori Minami,Kazuomi Ueshima,Takamichi Murakami,Shiro Miyayama,Osamu Nakashima,Hirohisa Yano,Michiie Sakamoto,Etsuro Hatano,Mitsuo Shimada,Norihiro Kokudo,Satoshi Mochida,Tetsuo Takehara +24 more
TL;DR: The Clinical Practice Manual for Hepatocellular Carcinoma (HCC) as mentioned in this paper was published by the Japan Society of Hepatology (JSH) expert panel in 2007, with emphasis on the consensus statements and recommendations for the management of HCC.
Journal ArticleDOI
Systemic treatment of hepatocellular carcinoma: An EASL position paper
TL;DR: The EASL Clinical Practice Guidelines on the management of hepatocellular carcinoma (HCC) have been updated in 2018 as mentioned in this paper to provide the best possible care for patients today.
Journal ArticleDOI
A Changing Paradigm for the Treatment of Intermediate-Stage Hepatocellular Carcinoma: Asia-Pacific Primary Liver Cancer Expert Consensus Statements
Masatoshi Kudo,Kwang Hyub Han,Sheng Long Ye,Jian Zhou,Yi Hsiang Huang,Shi-Ming Lin,Chung Kwe Wang,Masafumi Ikeda,Stephen L. Chan,Su Pin Choo,Shiro Miyayama,Ann-Lii Cheng +11 more
TL;DR: This manuscript summarizes the international consensus statements developed at APPLE 2019 and says that TACE should not be continued in patients who develop TACE failure/refractoriness in order to preserve liver function.
Journal ArticleDOI
A New Treatment Option for Intermediate-Stage Hepatocellular Carcinoma with High Tumor Burden: Initial Lenvatinib Therapy with Subsequent Selective TACE.
TL;DR: In this article, the authors proposed a lenvatinib-transarterial chemoembolization (TACE) sequential therapy for intermediate-stage hepatocellular carcinoma (HCC).
References
More filters
Journal ArticleDOI
Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012.
Jacques Ferlay,Isabelle Soerjomataram,Rajesh Dikshit,Sultan Eser,Colin Mathers,Marise Souto Rebelo,Donald Maxwell Parkin,David Forman,Freddie Bray +8 more
TL;DR: The GLOBOCAN series of the International Agency for Research on Cancer (IARC) as mentioned in this paper provides estimates of the worldwide incidence and mortality from 27 major cancers and for all cancers combined for 2012.
Journal ArticleDOI
Angiogenesis in cancer and other diseases
Peter Carmeliet,Rakesh K. Jain +1 more
TL;DR: Pathological angiogenesis is a hallmark of cancer and various ischaemic and inflammatory diseases and integrated understanding is leading to the development of a number of exciting and bold approaches to treat cancer and other diseases, but owing to several unanswered questions, caution is needed.
Journal ArticleDOI
EASL-EORTC clinical practice guidelines : management of hepatocellular carcinoma
Peter R. Galle,Alejandro Forner,Josep M. Llovet,Vincenzo Mazzaferro,Fabio Piscaglia,Jean-Luc Raoul,Peter Schirmacher,Valérie Vilgrain +7 more
TL;DR: The following Clinical Practice Guidelines will give up-to-date advice for the clinical management of patients with hepatocellular carcinoma, as well as providing an in-depth review of all the relevant data leading to the conclusions herein.
Journal ArticleDOI
Normalization of Tumor Vasculature: An Emerging Concept in Antiangiogenic Therapy
TL;DR: Emerging evidence supporting an alternative hypothesis is reviewed—that certain antiangiogenic agents can also transiently “normalize” the abnormal structure and function of tumor vasculature to make it more efficient for oxygen and drug delivery.
Journal ArticleDOI
Hepatocellular Carcinoma: Epidemiology and Molecular Carcinogenesis
TL;DR: A detailed understanding of epidemiologic factors and molecular mechanisms associated with HCC ultimately could improve current concepts for screening and treatment of this disease.
Related Papers (5)
Lenvatinib versus sorafenib in first-line treatment of patients with unresectable hepatocellular carcinoma: a randomised phase 3 non-inferiority trial
Masatoshi Kudo,Richard S. Finn,Shukui Qin,Kwang Hyub Han,Kenji Ikeda,Fabio Piscaglia,Ari David Baron,Joong-Won Park,Guohong Han,Jacek Jassem,Jean-Frédéric Blanc,Arndt Vogel,Dmitry Komov,T.R. Jeffry Evans,Carlos Lopez,Corina E. Dutcus,Matthew Guo,Kenichi Saito,Silvija Kraljevic,Toshiyuki Tamai,Min Ren,Ann-Lii Cheng +21 more
Atezolizumab plus Bevacizumab in Unresectable Hepatocellular Carcinoma
Richard S. Finn,Shukui Qin,Masafumi Ikeda,Peter R. Galle,Michel Ducreux,Tae-You Kim,Masatoshi Kudo,Valeriy Breder,Philippe Merle,Ahmed O Kaseb,Daneng Li,Wendy Verret,Derek-Zhen Xu,Sairy Hernandez,Juan Liu,Chen Huang,Sohail M. Mulla,Yulei Wang,Ho Yeong Lim,Andrew X. Zhu,Ann-Lii Cheng,IMbrave Investigators +21 more
Sorafenib in Advanced Hepatocellular Carcinoma
Josep M. Llovet,Sergio Ricci,Vincenzo Mazzaferro,Philip Hilgard,Edward Gane,Jean-Frédéric Blanc,André Cosme de Oliveira,Armando Santoro,Jean-Luc Raoul,Alejandro Forner,Myron Schwartz,Camillo Porta,Stefan Zeuzem,Luigi Bolondi,Tim F. Greten,Peter R. Galle,Jean Francois Seitz,Ivan Borbath,Dieter Häussinger,Tom Giannaris,Minghua Shan,M. Moscovici,D. Voliotis,Jordi Bruix +23 more
Regorafenib for patients with hepatocellular carcinoma who progressed on sorafenib treatment (RESORCE): a randomised, double-blind, placebo-controlled, phase 3 trial
Jordi Bruix,Shukui Qin,Philippe Merle,Alessandro Granito,Yi Hsiang Huang,György Bodoky,Marc Pracht,Osamu Yokosuka,Olivier Rosmorduc,Valeriy Breder,René Gerolami,Gianluca Masi,Paul Ross,Tianqiang Song,Jean-Pierre Bronowicki,Isabelle Ollivier-Hourmand,Masatoshi Kudo,Ann-Lii Cheng,Josep M. Llovet,Josep M. Llovet,Josep M. Llovet,Richard S. Finn,Marie Aude Leberre,Annette Baumhauer,Gerold Meinhardt,Guohong Han +25 more