Liver Function Changes in Patients with Hepatocellular Carcinoma Treated with Lenvatinib: Predictive Factors of Progression to Child-Pugh Class B, the Formation of Ascites and the Candidates for the Post-Progression Treatment.

Takeshi Hatanaka,Tamon Nagashima,Hiroki Tojima,Masashi Namikawa,Ken Shirabe,Satoru Kakizaki,Hirotaka Arai,Norifumi Harimoto,Takashi Ueno,Atsushi Naganuma,Daichi Takizawa,Ken Sato,Toshio Uraoka

doi:10.3390/cancers12102906

Abstract

Simple SummaryMany drugs has become available for the advanced hepatocellular carcinoma and sequential systemic therapies play an important role in the clinical settings. Because the key eligibility criteria for post-progression treatment included the performance status of ≦1 and Child-Pugh score of ≦6, to clarify the eligibility for post-progression treatment will provide meaningful information. The aim of this multicenter retrospective study was to investigate the predictive factors of progression to Child-Pugh class B, the formation of ascites and the candidates for post-progression treatment. Authors confirmed that male, ALBI grade 1, Child-Pugh score 5 (CP5A) and BCLC early or intermediate stage were favorable factors related to sustaining liver function and the patients with ALBI grade 1 and CP5A were eligible for the post-progression treatment. Careful screening for ascites was needed in patients with low platelet count and Child-Pugh score 6.The aim of this multicenter retrospective study was to assess the change in liver function in patients with hepatocellular carcinoma treated with lenvatinib. Among 139 consecutive patients receiving lenvatinib treatment between March 2018 and July 2019, 28 patients with Child-Pugh class B and one patient with inadequate patient information were excluded. Remaining 110 patients with Child-Pugh class A were analyzed. The median age of 110 patients was 73 years (IQR 66.7–80) and 88 patients (80.0%) were men. Child-Pugh score was 5 (CP5A) and 6 (CP6A) in 58 (52.7%) and 52 patients (47.3%), and ALBI grade was 1 and 2 in 38 (34.5%) and 72 patients (65.5%), respectively. The deterioration to Child-Pugh class B was found in 43 patients (39.1%) during the lenvatinib treatment. The favorable factors related to preserving liver function were significantly shown to be male, ALBI grade 1, CP5A and BCLC early or intermediate stage in the multivariate analysis. The formation of ascites was found in 32 patients (28.6%). The significant unfavorable factors associated with the formation of ascites were found to be low platelet count and CP6A. Among the 79 patients, there were 36 (45.6%) and 11 patients (13.9%) who fulfilled the criteria for candidate for the post-progression treatment and ramucirumab treatment, respectively. The predictive factors of the post-progression treatment were shown to be ALBI grade 1 and CP5A in multivariate analysis. In conclusion, male, ALBI grade 1, CP5A and BCLC early or intermediate stage were favorable factors related to sustaining liver function and the patients with ALBI grade 1 and CP5A were eligible for the post-progression treatment. Careful screening for ascites was needed in patients with low platelet count and CP6A.

Highlights

Liver cancer ranks second as the cause of cancer-related death for men and the sixth as the cause of cancer-related death for women worldwide [1] and hepatocellular carcinoma (HCC) is the most frequent type of primary liver cancer [2]
The aim of the current study is to investigate the predictive factors of progression to Child-Pugh class B (CP-B), the formation of ascites and the candidates for post-progression treatment
Among HCV-related HCC patients (n = 58), HCV eradication was achieved in 32 patients (55.2%)

Summary

Introduction

Liver cancer ranks second as the cause of cancer-related death for men and the sixth as the cause of cancer-related death for women worldwide [1] and hepatocellular carcinoma (HCC) is the most frequent type of primary liver cancer [2]. Regorafenib [13] and cabozantinib [14] demonstrated efficacy in second-line treatment and ramucirumab [15] provide the better outcome in patients with α-fetoprotein (AFP) = 400 ng/mL. These drugs recently have become widely used and sequential systemic therapies play an important role in the clinical setting. Key eligibility criteria for these second-line treatment included the performance status (PS) of 51 and Child-Pugh score of 56, there are few previous reports concerning about the frequency and the predictive factors of preserving PS and liver function in HCC patients after receiving lenvatinib. The aim of the current study is to investigate the predictive factors of progression to Child-Pugh class B (CP-B), the formation of ascites and the candidates for post-progression treatment

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