scholarly journals Successful Conversion Surgery for Massive Hepatocellular Carcinoma with Tumor Thrombus in Main Portal Vein after Treatment with Lenvatinib Combined with Toripalimab: A Case Report

2021 ◽  
Author(s):  
JingZhong OuYang ◽  
Yanzhao Zhou ◽  
Zhengzheng Wang ◽  
Qingjun Li ◽  
Jinxue Zhou
Keyword(s):  
Hepatocellular Carcinoma ◽  
Portal Vein ◽  
Tumor Thrombus ◽  
Inflammatory Cells ◽  
Complete Response ◽  
Advanced Hepatocellular Carcinoma ◽  
Main Portal Vein ◽  
Advanced Hcc ◽  
Dismal Prognosis ◽  
The Right

Abstract Background:Advanced hepatocellular carcinoma (HCC) with Portal vein invasion has an extremely dismal prognosis. We report a rare case of advanced HCC with portal vein tumor thrombus (PVTT). First, Lenvatinib(Len) combined with Toripalimab(Tor) was treated. The patient was successfully treated with radical surgical resection after the tumor thrombus shrank. Postoperative pathology showed complete response (CR).Case presentation:A 52-year-old male patient had a massive liver cancer in his right liver, and the tumor thrombus grew to the main portal vein. He passed 4 cycles of Len combined with Tor, the tumor shrank rapidly, the level of tumor markers dropped rapidly, The tumor thrombus was successfully confined from the main portal vein to the right branch of the portal vein. Therefore, the patient underwent a right hepatectomy and successfully removed a complete PVTT. Histopathological results showed that the primary tumor and tumor thrombus were only infiltrated by inflammatory cells, and there were no viable tumor cells.Conclusions:Len combined with Tor can be used as a preoperative neoadjuvant regimen for the treatment of advanced HCC with massive macrovascular invasion.

scholarly journals Transarterial Radioembolization Treatment of Advanced Hepatocellular Carcinoma Invading the Right Atrium

2021 ◽  
pp. 1-4
Author(s):  
Kabalane Yammine ◽  
◽  
Sarah Khalife ◽  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Inferior Vena Cava ◽  
Right Atrium ◽  
Tumor Thrombus ◽  
Inferior Vena ◽  
Vena Cava ◽  
Treatment Strategies ◽  
Complete Response ◽  
Advanced Hepatocellular Carcinoma ◽  
The Right

Tumor thrombus infiltration of hepatocellular carcinoma (HCC) into the inferior vena cava and right atrium is rare and is associated with a poor prognosis due to the critical location of the tumor and the limited efficiency of the available treatment strategies. In this study, we report the case of a patient with advanced HCC and tumor thrombus in the inferior vena cava and right atrium who demonstrated complete response with mass retraction upon Yttrium-90 trans-arterial radioembolization (90Y- TARE) therapy. Throughout the 16 months follow-ups after the radioembolization, the patient was free of any complications, revealing no occurrence of radiation-induced pneumonitis or tumor recurrence.

scholarly journals Transarterial Chemoembolization Combined with Lenvatinib plus PD-1 Inhibitor for Advanced Hepatocellular Carcinoma: A Retrospective Cohort Study

2021 ◽  
Author(s):  
Mingyue Cai ◽  
Wensou Huang ◽  
Jingjun Huang ◽  
Wenbo Shi ◽  
Yongjian Guo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hepatocellular Carcinoma ◽  
Portal Vein ◽  
Extrahepatic Metastasis ◽  
Advanced Hepatocellular Carcinoma ◽  
Main Portal Vein ◽  
Portal Vein Invasion ◽  
Advanced Hcc ◽  
Tumor Number ◽  
Independent Risk Factors

Abstract Purpose To investigate the efficacy and safety of transarterial chemoembolization (TACE) combined with lenvatinib plus PD-1 inhibitor (TACE-L-P) versus TACE combined with lenvatinib (TACE-L) for patients with advanced hepatocellular carcinoma (HCC).Methods Data of advanced HCC patients treated with TACE-L-P or TACE-L from January 2019 to December 2020 were retrospectively analyzed. The differences in overall survival (OS), progression-free survival (PFS), tumor responses (based on modified Response Evaluation Criteria in Solid Tumors) and adverse events (AEs) were compared between the two groups. Potential factors affecting OS and PFS were determined.Results A total of 81 patients were included in this study (41 received TACE-L-P and 40 received TACE-L). The patients in TACE-L-P group had prolonged OS (median, 16.9 vs. 12.1 months, p=0.009), longer PFS (median, 7.3 vs. 4.0 months, p=0.002) and higher objective response rate (56.1% vs. 32.5%, p=0.033) and disease control rate (85.4% vs. 62.5%, p=0.019) than those in TACE-L group. Multivariate analyses revealed that the treatment option of TACE-L, main portal vein invasion and extrahepatic metastasis were the independent risk factors for OS, while TACE-L and extrahepatic metastasis were the independent risk factors for PFS. In subgroup analyses, a superior survival benefit was achieved with TACE-L-P in patients with extrahepatic metastasis or tumor number >3 but not in those with main portal vein invasion. The incidence and severity of AEs in TACE-L-P group were comparable to those in TACE-L group (any grade, 92.7% vs. 95.0%, p=1.000; grade 3, 36.6% vs. 32.5%, p=0.699).Conclusion TACE-L-P significantly improved survival over TACE-L with an acceptable safety profile in advanced HCC patients, especially those with extrahepatic metastasis or tumor number >3 but without main portal vein invasion.

scholarly journals Conversion hepatectomy for advanced hepatocellular carcinoma after right portal vein transection and lenvatinib therapy

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Yuki Ohya ◽  
Shintaro Hayashida ◽  
Akira Tsuji ◽  
Kunitaka Kuramoto ◽  
Hidekatsu Shibata ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Portal Vein ◽  
Kinase Inhibitor ◽  
Sharp Decrease ◽  
Hepatic Function ◽  
Advanced Hepatocellular Carcinoma ◽  
Right Hepatectomy ◽  
Advanced Hcc ◽  
Extended Right Hepatectomy ◽  
The Right

Abstract Background Lenvatinib is a novel tyrosine kinase inhibitor that exhibits an antitumor effect on hepatocellular carcinoma (HCC). An established strategy that involves surgery and usage of lenvatinib for advanced HCC remains elusive. Case presentation A 58-year-old male patient with advanced HCC and untreated hepatitis B was referred to our hospital. The tumor at the right lobe was 10 cm in diameter with right portal vein thrombus. Because of the possible lung metastasis and concern about the remaining hepatic function after extended right hepatectomy, lenvatinib was initiated before surgery. After the confirmation of a sharp decrease of tumor markers during the 3-week lenvatinib therapy, only a right portal vein transection was done leaving the enlargement of the left lobe for improved post-hepatectomy liver function while lenvatinib therapy was continued. The laparotomy revealed that the tumor was invading the right diaphragm. After 7 weeks of lenvatinib administration after right portal vein transection, an extended right hepatectomy with resection of the tumor-invaded diaphragm was successfully done. The lung nodules that were suspected as metastases had disappeared. The patient has been doing well without any sign of recurrence for 1 year. Conclusion The strategy involving the induction of lenvatinib to conversion hepatectomy including the portal vein transection was effective for advanced HCC.

scholarly journals Efficacy and Safety of Lenvatinib for Advanced Hepatocellular Carcinoma Patients Beyond REFLECT Study Indications in a Real-World Setting in China

2021 ◽  
Author(s):  
Guangxin Li ◽  
Yu Zhang ◽  
Yanmei Yang ◽  
Gong Li
Keyword(s):  
Hepatocellular Carcinoma ◽  
Adverse Events ◽  
Portal Vein ◽  
Real World ◽  
Tumor Thrombus ◽  
Liver Volume ◽  
Portal Vein Tumor Thrombus ◽  
Advanced Hepatocellular Carcinoma ◽  
Main Portal Vein ◽  
Real World Setting

Abstract Background/purpose: Lenvatinib was found to be non-inferior to sorafenib in a Phase 3 REFLECT trial on advanced hepatocellular carcinoma. However, patients with a liver tumor volume of greater than 50% of total liver volume or with main portal vein tumor thrombus, which often occurs in clinical practice, were excluded from the REFLECT trial. This study aimed to examine the safety and efficacy of lenvatinib on patients beyond REFLECT study indications in a real-world setting.Method: This was a retrospective, single-center observational study focused on unresectable hepatocellular carcinoma (u-HCC) patients with the tumor accounting for more than 50% of the liver volume or with main portal vein tumor thrombus. From June 2018 to February 2019, 21 u-HCC patients with above characteristics were enrolled. The therapeutic effects were determined using the modified Response Evaluation Criteria in Solid Tumors (m-RECIST) in the 12th week. Grades of adverse events followed with the Common Terminology Criteria for Adverse Events version (CTCAE) 4.0. The median Progression-Free Survival (PFS) and median Over Survival (OS) were determined at the 12th month.Results: The median observation period was 11.5 months. Fatigue, leukopenia and dysphoria were the most frequent adverse events. Leukopenia, hand-foot skin reaction and decreased appetite were the most frequent adverse events, and were higher than Grade 2. 7 of the patients had elevated Child-Pugh scores, 3 of whom increased from Child-Pugh A to B. All of the adverse events could be controlled by appropriate dose reduction, interruption and symptomatic treatment. No liver function failure occurred. The probability of tumor marker (AFP or PIVKA-II) decline was 100% and 60% at one month and three months after administration respectively. In the m-RECIST evaluation in the 12th week, 0, 7, 7 and 7 patients achieved complete response, partial response, stable disease and progressive disease respectively. The objective response rate was 33.3%. The median PFS and OS was 5.3 and 11.2 , respectively. 1 year survival rate was 42.9%.Conclusion: Lenvatinib treatment can be accomplished with safety and a good response for patients beyond REFLECT study indications in a real-world setting.

scholarly journals Hypothyroidism Is a Predictive Factor for Better Clinical Outcomes in Patients with Advanced Hepatocellular Carcinoma Undergoing Lenvatinib Therapy

Cancers ◽  
2020 ◽  
Vol 12 (11) ◽  
pp. 3078
Author(s):  
Masako Shomura ◽  
Haruka Okabe ◽  
Emi Sato ◽  
Kota Fukai ◽  
Koichi Shiraishi ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Treatment Duration ◽  
Hormone Replacement ◽  
Evaluation Criteria ◽  
Complete Response ◽  
Good Prognosis ◽  
Advanced Hepatocellular Carcinoma ◽  
Thyroid Hormone Replacement ◽  
Advanced Hcc ◽  
Therapy Initiation

Patients with advanced hepatocellular carcinoma (HCC) undergoing molecular targeted therapy often experience non-negligible adverse events (AEs). Paradoxically, certain AEs are reportedly associated with a good prognosis. We aimed to identify factors predictive of treatment duration and overall survival (OS) in patients with HCC undergoing lenvatinib therapy. Forty-six consecutive patients with advanced HCC who received lenvatinib therapy from April 2018 to November 2019 were prospectively followed until November 2019. Treatment efficacy was assessed according to the modified Response Evaluation Criteria in Solid Tumors for 2–3 months after therapy initiation. The disease control rate (DCR) was defined as the percentage of patients with a complete response, partial response, or stable disease. The DCR was 65.2%, with a median survival of 10.2 months. Grade 2/3 hypoalbuminemia resulted in shorter treatment duration. Factors predictive of longer OS were a Child-Pugh score of 5 at baseline and the occurrence of Grade 2/3 hypothyroidism. Conversely, Grade 2/3 hypoalbuminemia was associated with a poorer prognosis. An AE of Grade 2/3 hypothyroidism was associated with a better prognosis in patients receiving lenvatinib treatment for advanced HCC. Continuing anticancer therapy with appropriate thyroid hormone replacement may contribute to longer OS.

Phase Ib trial of tepotinib in Asian patients with advanced hepatocellular carcinoma (HCC): Final data including long-term outcomes.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 4087-4087 ◽  
Author(s):  
Shukui Qin ◽  
Tae-You Kim ◽  
Ho Yeong Lim ◽  
Baek-Yeol Ryoo ◽  
Jürgen Scheele ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Progression Free Survival ◽  
Response Duration ◽  
Complete Response ◽  
Maximum Tolerated Dose ◽  
Advanced Hepatocellular Carcinoma ◽  
Modest Improvement ◽  
Phase Ib ◽  
Advanced Hcc ◽  
Ecog Ps

4087 Background: The incidence of hepatocellular carcinoma (HCC), a leading cause of cancer death, is increasing with the increasing incidence of chronic liver disease. Sorafenib, the only approved systemic therapy for advanced HCC, provides modest improvement in overall survival. Preclinical studies suggest c-Met is a valid target in HCC, but non-selective TKIs with c-Met inhibitory activity have not shown efficacy in trials, possibly due to lack of c-Met inhibition. Tepotinib (MSC2156119J) is a highly selective c-Met inhibitor that has favorable safety and promising activity, particularly against c-Met+ solid tumors. We report the final results of a phase Ib trial of tepotinib in patients (pts) with advanced HCC. Methods: Pts were Asian adults with confirmed HCC of BCLC Stage C, Child-Pugh Class A liver function without encephalopathy, and ECOG PS 0–2. Pts received tepotinib 300, 500 (the RP2D) or 1,000 mg/day on a 21-day cycle. c-Met expression status was retrospectively determined by IHC. Results: 27 pts were enrolled (median age 57 [38-69]; male 23; ECOG PS 0/1 11/16); 7 received tepotinib 300 mg/day, 14 500 mg/day, and 6 1,000 mg/day (3 with dose reduction). No DLTs were observed. 22 pts experienced treatment-related treatment-emergent adverse events (TRTEAEs), most commonly diarrhea (n = 10), nausea (8), elevated AST (7), and elevated ALT (6). 9 pts had grade ≥3 TRTEAEs, including elevated AST (3) and elevated ALT (3). Best overall response (BOR) was partial response (PR) in 2 pts, one of whom received tepotinib 500 mg (response duration 16.1 months) and one 1,000 mg (4.4 months); both had c-Met+ tumors. A further 8 pts had a BOR of stable disease (SD), 1 pt non-complete response (CR)/non-progressive disease (PD), and 14 pts had PD (2 pts not evaluable). Five pts had progression free survival > 8 months. PK were as expected from previous studies. Conclusions: Tepotinib at doses of up to 1,000 mg/day was well tolerated by Asian pts with advanced HCC and a maximum tolerated dose was not reached. Antitumor activity was observed, particularly in pts with c-Met+ tumors. The ongoing phase II part of this study is comparing the efficacy and safety of first-line tepotinib and sorafenib in pts with c-Met+ HCC. Clinical trial information: NCT01988493.

scholarly journals Hepatocellular Carcinoma With Tumor Thrombus Occupying the Right Atrium and Portal Vein

Medicine ◽  
2015 ◽  
Vol 94 (34) ◽  
pp. e1049 ◽  
Author(s):  
Xin Luo ◽  
Binhao Zhang ◽  
Shuilin Dong ◽  
Bixiang Zhang ◽  
Xiaoping Chen
Keyword(s):  
Hepatocellular Carcinoma ◽  
Portal Vein ◽  
Right Atrium ◽  
Tumor Thrombus ◽  
The Right
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