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Abstract
Use of lenvatinib, which has a high response rate in advanced hepatocellular carcinoma, sometimes results in tumor shrinkage and resectability of previously unresectable liver cancers. In Asia, including Japan, liver reserve, one of the determinants of resectability, is mainly determined by the indocyanine green (ICG) retention rate. Three patients with advanced liver cancer treated at our institution had very poor ICG retention rates during treatment with lenvatinib. Lenvatinib may reduce blood flow in both cancerous and non-cancerous regions by inhibiting vascular endothelial growth factor. Therefore, accurate determination of liver function likely requires withdrawal of this treatment several days before ICG retention testing.
Highlights
Lenvatinib was approved as a first-line treatment after a head-to-head trial with sorafenib, which had previously been the standard of care in accordance with the findings of the REFLECT study [1]
We here present three patients whose indocyanine green (ICG) retention rates improved after several rounds of lenvatinib withdrawal (Table 1), indicating that conversion surgery was feasible despite our initial erroneous conclusion, which was based on the poor ICG retention rate on lenvatinib, that it was contraindicated
When we became aware of the possibility of disordered blood flow in non-cancerous tissues, we withdrew lenvatinib until it would have largely been cleared from the blood, by which time the ICG retention rate had improved
Summary
Lenvatinib was approved as a first-line treatment after a head-to-head trial with sorafenib, which had previously been the standard of care in accordance with the findings of the REFLECT study [1]. We report three patients with such poor ICG retention rates that surgery was considered contraindicated despite tumor shrinkage by lenvatinib. In these cases, when the ICG retention rate was reassessed several days after lenvatinib withdrawal, it had improved to the degree that these patients’ tumors were deemed suitable for conversion therapy.
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