Lenvatinib for large hepatocellular carcinomas with portal trunk invasion: Two case reports.

Abstract

BACKGROUND:

In a phase III trial of lenvatinib as first-line treatment for advanced unresectable hepatocellular carcinoma (uHCC), the drug proved non-inferior to sorafenib in terms of the overall survival, but offered better progression-free survival. However, the effects of lenvatinib in uHCC patients with a tumor thrombus in the main portal vein and/or a high tumor burden (tumor occupancy more than 50% of the total liver volume), remain unclear, because these were set as exclusion criteria in the aforementioned trial.

CASE SUMMARY:

A 53-year-old man (case 1) and 66-year-old woman (case 2) with uHCC presented to us with a tumor thrombus in both the main portal vein and inferior vena cava, a high tumor burden accompanied by a tumor diameter greater than > 100 mm, and distant metastasis, with the residual liver function classified as grade 2A according to the modified Albumin-Bilirubin grading. We started both patients on lenvatinib. The therapeutic effect, as evaluated by the modified Response Evaluation Criteria in Solid Tumors, was rated as partial response in both case 1 and case 2 (at 8 wk and 4 wk after the start of lenvatinib administration, respectively). The therapeutic effect was sustained for 6 mo in case 1 and 20 mo in case 2. Fever occurred as an adverse event in both case 1 and 2, and hyperthyroidism and thrombocytopenia in only case 2, neither of which, however, necessitated treatment discontinuation.

CONCLUSION:

Even in hepatocellular carcinoma patients with poor prognostic factors, if the liver function is well-preserved, lenvatinib is effective and safe.

• Authors: Satoshi Komiyama, Kazushi Numata, Satoshi Moriya, Hiroyuki Fukuda, Makoto Chuma, Shin Maeda
• Journal: World journal of clinical cases (World J Clin Cases) Vol. 8 Issue 12 Pg. 2574-2584 (Jun 26 2020) ISSN: 2307-8960 [Print] United States
• PMID: 32607334 (Publication Type: Case Reports)
• Copyright: ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.