Abstract
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.
Highlights
Liver cancer is the sixth most frequent malignant tumor and fourth most common cause of cancer death worldwide, with 841,000 patients newly diagnosed and 782,000 cancer deaths annually [1]
We reported that Barcelona Clinic Liver Cancer (BCLC) intermediate stage was a significant predictive factor that was associated with the objective response rate (ORR) in a multivariate analysis [18], which agreed with the results regarding the ORRs in the analysis of a Japanese subpopulation in the REFLECT trial [27]
Lenvatinib was associated with a good therapeutic response in patients with advanced
Summary
Liver cancer is the sixth most frequent malignant tumor and fourth most common cause of cancer death worldwide, with 841,000 patients newly diagnosed and 782,000 cancer deaths annually [1]. The European Association for the Study of the Liver (EASL) recommended the indication of lenvatinib for BCLC advanced stage (without tumor thrombosis at the main portal vein) and HCC that shows progression with or which is unsuitable for locoregional therapy in patients with Child-Pugh class A and good performance status (PS) [2]. The efficacy and safety of lenvatinib remains unknown for these patients because the REFLECT trial excluded patients who had received systemic therapy, and those with portal vein invasion at the main portal trunk, bile duct invasion, liver occupation of tumor ≥ 50% and Child-Pugh class B This present article reviewed the therapeutic response, the management of adverse events, post-progression therapy, and treatment strategy for the BCLC intermediate stage
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