Analysis of Post-Progression Survival in Patients with Unresectable Hepatocellular Carcinoma Treated with Lenvatinib.

Abstract

BACKGROUND:

Although a strong antitumor effect of lenvatinib (LEN) has been noted for patients with unresectable hepatocellular carcinoma (HCC), there are still no reports on the prognosis for patients with disease progression after first-line LEN therapy.

METHODS:

Patients (n = 141) with unresectable HCC, Child-Pugh class A liver function, and an Eastern Cooperative Oncology Group performance status (ECOG-PS) of 0 or 1 who were treated with LEN from March 2018 to December 2019 were enrolled.

RESULTS:

One hundred and five patients were treated with LEN as first-line therapy, 53 of whom had progressive disease (PD) at the radiological evaluation. Among the 53 patients with PD, there were 27 candidates for second-line therapy, who had Child-Pugh class A liver function and an ECOG-PS of 0 or 1 at progression. After progression on first-line LEN, 28 patients were treated with a molecular targeted agent (MTA) as second-line therapy (sorafenib: n = 26; ramucirumab: n = 2). Multivariate analysis identified modified albumin-bilirubin grade 1 or 2a at LEN initiation (odds ratio 5.18, 95% confidence interval [CI] 1.465-18.31, p = 0.011) as a significant and independent factor for candidates. The median post-progression survival after PD on first-line LEN was 8.3 months. Cox hazard multivariate analysis showed that a low alpha-fetoprotein level (<400 ng/mL; hazard ratio [HR] 0.297, 95% CI 0.099-0.886, p = 0.003), a relative tumor volume <50% at the time of progression (HR 0.204, 95% CI 0.07-0.592, p = 0.03), and switching to MTAs as second-line treatment after LEN (HR 0.299, 95% CI 0.12-0.746, p = 0.01) were significant prognostic factors.

CONCLUSION:

Among patients with PD on first-line LEN, good liver function at introduction of LEN was an important and favorable factor related to eligibility for second-line therapy. In addition, post-progression treatment with MTAs could improve the prognosis for patients who had been treated with first-line LEN.

• Authors: Yuwa Ando, Tomokazu Kawaoka, Yosuke Suehiro, Kenji Yamaoka, Yumi Kosaka, Shinsuke Uchikawa, Kenichiro Kodama, Kei Morio, Hatsue Fujino, Takashi Nakahara, Eisuke Murakami, Masami Yamauchi, Masataka Tsuge, Akira Hiramatsu, Takayuki Fukuhara, Nami Mori, Shintaro Takaki, Keiji Tsuji, Michihiro Nonaka, Hideyuki Hyogo, Yasuyuki Aisaka, Keiichi Masaki, Yoji Honda, Takashi Moriya, Noriaki Naeshiro, Takahiro Azakami, Shoichi Takahashi, Michio Imamura, Kazuaki Chayama, Hiroshi Aikata
• Journal: Oncology (Oncology) Vol. 98 Issue 11 Pg. 787-797 ( 2020) ISSN: 1423-0232 [Electronic] Switzerland
• PMID: 32882687 (Publication Type: Journal Article)
• Copyright: © 2020 S. Karger AG, Basel.

Chemical References

• Antibodies, Monoclonal, Humanized
• Antineoplastic Agents
• Phenylurea Compounds
• Protein Kinase Inhibitors
• Quinolines
• Sorafenib
• lenvatinib

Topics

• Aged
• Aged, 80 and over
• Antibodies, Monoclonal, Humanized (therapeutic use)
• Antineoplastic Agents (therapeutic use)
• Carcinoma, Hepatocellular (drug therapy, mortality, pathology)
• Cohort Studies
• Disease Progression
• Female
• Humans
• Liver Neoplasms (drug therapy, mortality, pathology)
• Male
• Middle Aged
• Molecular Targeted Therapy
• Phenylurea Compounds (therapeutic use)
• Protein Kinase Inhibitors (therapeutic use)
• Quinolines (therapeutic use)
• Retrospective Studies
• Sorafenib (therapeutic use)
• Survival Rate
• Ramucirumab