Liver Function in Older Patients With Unresectable Hepatocellular Carcinoma After Administration of Lenvatinib

Background: Recent advances in the development of tyrosine kinase inhibitors (TKIs) have enabled patients with unresectable hepatocellular carcinoma (HCC) to receive multiple TKIs in sequence. The aim of this study was to identify predictors of good candidates for second-line treatment after disease progression during sorafenib treatment. Methods: This is a retrospective cohort study of 190 consecutive HCC patients who were treated with sorafenib in our hospital. Three criteria of good candidates for second-line TKI at the time of disease progression during sorafenib treatment were defined as follows: criterion 1 was the same as the inclusion criteria of the regorafenib for patients with hepatocellular carcinoma who progressed on sorafenib treatment (RESORCE) study, criterion 2 was the inclusion criteria of the RESORCE study plus Child–Pugh score 5, and criterion 3 was the inclusion criteria of the RESORCE study plus albumin–bilirubin (ALBI) grade 1. Factors at baseline and at week 4 during sorafenib treatment were used to predict patients fulfilling each of these three criteria. Results: The distribution of patients was 29%, 13%, and 6% in criteria 1, 2, and 3, respectively. Significant factors for meeting criterion 1 was the combination of baseline albumin >3.7 g/dL (odds ratio (OR) 2.7) plus degree of decrease in albumin (Δalbumin) at week 4 <0.2 g/dL (OR 2.6), or the combination of baseline ALBI score <−2.33 (OR 2.5) and ΔALBI at week 4 <0.255 (OR 4.9). For criterion 2, the value of baseline albumin and ALBI score was identical to criterion 1; however, Δalbumin (<0.1 g/dL) and ΔALBI score (<0.19) became stricter. For criterion 3, the value of baseline albumin (>3.8 g/dL) and ALBI (<−2.55) became stricter, as did Δalbumin (<0.1 g/dL) and ΔALBI (<0.085). Furthermore, tumor burden (>11) was selected as an additional predictor (OR 5.4). Conclusion: Predictors to satisfy the RESORCE study inclusion criteria were as follows: preserved liver function at baseline, as reflected by albumin or ALBI score, and small deterioration of liver function early during sorafenib therapy, as reflected by Δalbumin or ΔALBI at week 4. Liver function at baseline and degree of change in liver function during sorafenib treatment need to be stricter for better outcomes of liver function with disease progression.

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1003P Baseline (BL) liver function and outcomes in patients (pts) with unresectable hepatocellular carcinoma (HCC) in KEYNOTE-240

Annals of Oncology ◽

10.1016/j.annonc.2020.08.1119 ◽

2020 ◽

Vol 31 ◽

pp. S696-S697

Author(s):

A. Vogel ◽

P. Merle ◽

C. Verslype ◽

R.S. Finn ◽

A.X. Zhu ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Function ◽

Unresectable Hepatocellular Carcinoma

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Impact of hepatic function and tumor extent on survival in patients with unresectable hepatocellular carcinoma treated with liver-directed therapies.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.4_suppl.358 ◽

2016 ◽

Vol 34 (4_suppl) ◽

pp. 358-358

Author(s):

Marisa E. Hill ◽

Sanjib Basu ◽

Bulent Arslan

Keyword(s):

Hepatocellular Carcinoma ◽

Overall Survival ◽

Liver Function ◽

Proportional Hazards ◽

Medical Center ◽

Cox Proportional Hazards ◽

Rank Test ◽

Unresectable Hepatocellular Carcinoma ◽

The Difference ◽

Tumor Extent

358 Background: Transarterial chemoembolization (TACE) has demonstrated survival advantage over best supportive care in patients with unresectable hepatocellular carcinoma (HCC), and non-randomized data suggests that survival in HCC treated with yttrium-90 radioembolization (90Y) is similar to that achieved with TACE. Eighty to 90% of patients with HCC have underlying cirrhosis, so survival analyses of liver-directed treatments (LDT) should take into account both tumor extent and liver function. Methods: We conducted a retrospective study to evaluate the effect of tumor extent and liver function on the survival of patients treated with TACE and/or 90Y for HCC. Patients with unresectable HCC treated at Rush University Medical Center between 2002 and 2014 were analyzed. Liver function parameters prior to first treatment were recorded for each patient, and survival measured from time of first treatment to death or last follow up was calculated. Statistical inference for overall survival was performed using Kaplan-Meier method, log-rank test, and Cox proportional hazards regression model. Results: The difference in overall survival between patients with unilobar disease and with bilobar disease (n=35 and 23, median survival of 19.4 and 12.8 months, respectively) was not found to be significant (p=0.838). However, the difference in overall survival among patients with Child Pugh A (n=22, median not reached), B (n=30, median= 11.4 months) and C (n=6, median=3.8 months) cirrhosis was strongly significant (p < 0.001). In a multivariate Cox proportional hazards analysis, the association of Child class (coded on an integer scale) with overall survival, adjusted by the extent of the disease, continued to be strongly significant (HR=1.93, p < 0.001). Conclusions: Liver function may be just as important a determinant of survival in patients undergoing liver directed treatments for HCC as is extent of disease. Larger, prospective studies are needed to confirm this hypothesis.

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Baseline Liver Function and Subsequent Outcomes in the Phase 3 REFLECT Study of Patients with Unresectable Hepatocellular Carcinoma

Liver Cancer ◽

10.1159/000516490 ◽

2021 ◽

pp. 1-12

Author(s):

Arndt Vogel ◽

Catherine Frenette ◽

Max Sung ◽

Bruno Daniele ◽

Ari Baron ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Function ◽

Objective Response ◽

Progression Free Survival ◽

Efficacy And Safety ◽

Phase 3 ◽

Free Survival ◽

Unresectable Hepatocellular Carcinoma ◽

Post Hoc ◽

Treatment Emergent Adverse Event

Introduction: Baseline liver function among patients starting treatment for unresectable hepatocellular carcinoma (uHCC) impacts survival and could impact efficacy outcomes and safety profiles of treatments. This post hoc analysis of the phase 3 REFLECT study examined the efficacy and safety outcomes for lenvatinib and for sorafenib in patients with uHCC, assessed by Child-Pugh score (CPS) and albumin-bilirubin (ALBI) grade. Methods: Efficacy and safety were assessed in patient cohorts from REFLECT according to study entry baseline ALBI grade and CPS. Results: Lenvatinib treatment generally provided survival benefits in all groups. Median overall survival (OS) among patients with an ALBI grade of 1 was consistently higher than among patients with an ALBI grade of 2 for both the lenvatinib and sorafenib arms (lenvatinib: 17.4 vs. 8.6 months; sorafenib: 14.6 vs. 7.7 months, respectively). Median OS among patients with a CPS of 5 was consistently higher than among patients with a CPS of 6 (lenvatinib: 15.3 vs. 9.4 months; sorafenib: 14.2 vs. 7.9 months, respectively). Progression-free survival and objective response rates for these ALBI grades and CPS demonstrated similar patterns. Among patients who received lenvatinib and experienced a treatment-related treatment-emergent adverse event leading to withdrawal, 6.6% had an ALBI grade of 1, while 13.3% had an ALBI grade of 2, and 7.9% had a CPS of 5, while 12.1% had a CPS of 6. Conclusions: Better liver function at baseline, as measured by ALBI grade or CPS, may be prognostic for better survival outcomes in patients with uHCC undergoing treatment with lenvatinib or sorafenib.

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80 EUROPEAN NETWORK ON RADIOEMBOLISATION WITH 90Y-RESIN MICROSPHERES (ENRY) MULTICENTRE EVALUATION OF SURVIVAL, SAFETY AND LIVER FUNCTION FOR UNRESECTABLE HEPATOCELLULAR CARCINOMA (HCC)

Journal of Hepatology ◽

10.1016/s0168-8278(11)60082-2 ◽

2011 ◽

Vol 54 ◽

pp. S36 ◽

Cited By ~ 1

Author(s):

B. Sangro ◽

G.M. Ettorre ◽

R. Cianni ◽

D. Gasparini ◽

R. Golfieri ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Function ◽

European Network ◽

Unresectable Hepatocellular Carcinoma ◽

Resin Microspheres

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Mechanisms of liver damage in COVID-19

Medical alphabet ◽

10.33667/2078-5631-2020-19-39-46 ◽

2020 ◽

Vol 1 (19) ◽

pp. 39-46

Author(s):

T. V. Pinchuk ◽

N. V. Orlova ◽

T. G. Suranova ◽

T. I. Bonkalo

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Transplantation ◽

Risk Factor ◽

Liver Disease ◽

Liver Function ◽

Liver Damage ◽

The World ◽

Coronavirus Infection ◽

The Impact ◽

Analyze Data

At the end of 2019, a new coronavirus (SARS-CoV-2) was discovered in China, causing the coronavirus infection COVID-19. The ongoing COVID-19 pandemic poses a major challenge to health systems around the world. There is still little information on how infection affects liver function and the significance of pre-existing liver disease as a risk factor for infection and severe COVID-19. In addition, some drugs used to treat the new coronavirus infection are hepatotoxic. In this article, we analyze data on the impact of COVID-19 on liver function, as well as on the course and outcome of COVID-19 in patients with liver disease, including hepatocellular carcinoma, or those on immunosuppressive therapy after liver transplantation.

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