scholarly journals 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

Cancers ◽  
2020 ◽  
Vol 12 (10) ◽  
pp. 2906
Author(s):  
Takeshi Hatanaka ◽  
Satoru Kakizaki ◽  
Tamon Nagashima ◽  
Masashi Namikawa ◽  
Takashi Ueno ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Multivariate Analysis ◽  
Platelet Count ◽  
Liver Function ◽  
Predictive Factors ◽  
Intermediate Stage ◽  
Class B ◽  
Low Platelet Count ◽  
Pugh Class ◽  
Careful Screening

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.

Unresectable hepatocellular carcinoma: prospects for drug therapy with lenvatinib

2022 ◽  
Vol 11 (3) ◽  
pp. 45-52
Author(s):  
V.  V. Breder ◽  
D.  T. Abdurakhmanov ◽  
V.  V. Petkau ◽  
P.  V. Balakhnin ◽  
M.  V. Volkonsky ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Drug Therapy ◽  
Liver Function ◽  
Real World ◽  
Systemic Therapy ◽  
Efficacy And Safety ◽  
Study Results ◽  
Class B ◽  
Pugh Class ◽  
Positive Results

There is a number of unresolved issues regarding the systemic therapy administration for hepatocellular carcinoma (HCC). Their solution is facilitated by accumulating real‑world study results. Lenvatinib therapy is a recognized drug with a good efficacy and safety profile for the treatment of HCC. Subanalyses of the REFLECT study showed that the absence of stratification by baseline AFP and baseline liver function, as well as the lack of options for subsequent drug therapy after lenvatinib, also affects the outcomes. Once these factors are taken into account, the hypothesis of superiority of lenvatinib to sorafenib and other drugs can be tested. Real‑world clinical studies have demonstrated positive results of lenvatinib therapy in patients with Child‑Pugh class B liver function, provided recommendations on the sequence of systemic therapy after lenvatinib and on the use of lenvatinib in patients with BCLC stage B, along with considering the possibility of lenvatinib monotherapy and the prospects for its use in patients with nHCC. Further real‑world studies of lenvatinib for HCC in the Russian population are required.

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

Oncology ◽  
2020 ◽  
Vol 98 (11) ◽  
pp. 787-797 ◽  
Author(s):  
Yuwa Ando ◽  
Tomokazu Kawaoka ◽  
Yosuke Suehiro ◽  
Kenji Yamaoka ◽  
Yumi Kosaka ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Multivariate Analysis ◽  
Liver Function ◽  
Second Line ◽  
First Line ◽  
Second Line Therapy ◽  
Class A ◽  
Line Therapy ◽  
Pugh Class ◽  
Ecog Ps

<b><i>Background:</i></b> 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. <b><i>Methods:</i></b> Patients (<i>n</i> = 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. <b><i>Results:</i></b> 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: <i>n</i> = 26; ramucirumab: <i>n</i> = 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, <i>p</i> = 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 (&#x3c;400 ng/mL; hazard ratio [HR] 0.297, 95% CI 0.099–0.886, <i>p</i> = 0.003), a relative tumor volume &#x3c;50% at the time of progression (HR 0.204, 95% CI 0.07–0.592, <i>p</i> = 0.03), and switching to MTAs as second-line treatment after LEN (HR 0.299, 95% CI 0.12–0.746, <i>p</i> = 0.01) were significant prognostic factors. <b><i>Conclusion:</i></b> 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.

scholarly journals Complete response to the combination of Lenvatinib and Pembrolizumab in an advanced hepatocellular carcinoma patient: a case report

BMC Cancer ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Zhaonan Liu ◽  
Xingjie Li ◽  
Xuequn He ◽  
Yingchun Xu ◽  
Xi Wang
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Function ◽  
Arterial Embolization ◽  
Complete Response ◽  
Advanced Hepatocellular Carcinoma ◽  
Class B ◽  
Embolization Treatment ◽  
History Of ◽  
Pugh Class ◽  
Patient’S History

Abstract Background The majority of patients diagnosed with hepatocellular carcinoma (HCC) have advanced diseases and many are not eligible for curative therapies. Case presentation We report a rare case of HCC from a patient who had a complete response (CR) with the use of combination of Lenvatinib and Pembrolizumab. A 63-year-old man presented at the hospital with serious abdominal pain and was found to have a mass with heterogeneous enhancement and with hemorrhage in segment III of the liver after the examination of abdominal computerized tomography (CT) scan. The patient’s history of viral hepatitis B infection, liver cirrhosis and the ɑ-fetoprotein (AFP) level of 14,429.3 ng/ml supported the clinical diagnosis of HCC and laboratory results demonstrated liver function damage status (Child-Pugh class B, Score 8). The patient first received hepatic arterial embolization treatment on 28th November 2017. At this stage supportive care was recommended for poor liver function. In February 2018, combined immunotherapy of Pembrolizumab (2 mg/kg, q3w) and Lenvatinib (8 mg–4 mg, qd) were performed. Nine months following the treatment he had a CR and now, 22 months since the initial treatment, there is no clinical evidence of disease progression. The current overall survival is 22 months. Conclusions HCC is a potentially lethal malignant tumor and the combination of immunotherapy plus anti-angiogenic inhibitors shows promising outcome for advanced diseases.

Clinical outcomes of hepatocellular carcinoma patients with Child-Pugh class B treated with stereotactic body radiation therapy.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 560-560
Author(s):  
J Richelcyn Baclay ◽  
Diego Augusto Santos Toesca ◽  
Rie von Eyben ◽  
Madeline Minneci ◽  
Erqi L. Pollom ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Function ◽  
Clinical Laboratory ◽  
Score Change ◽  
Related Data ◽  
Institutional Review Board Approval ◽  
Institutional Review ◽  
Class B ◽  
Pugh Class

560 Background: Caution is usually employed in the treatment of patients with hepatocellular carcinoma (HCC) due to the inherent liver radiosensitivity, especially in patients with Child Pugh (CP) B and C classes. This study aims to review the outcomes of patients treated with SBRT for CP class B with HCC. Methods: Medical records of all patients with HCC and compromised liver function (CP class B) treated with SBRT between 2003 and 2018 were retrieved after institutional review board approval. Clinical, laboratory, and treatment-related data were collected and analyzed for their correlation to toxicity and survival. Liver function was assessed prior to SBRT and at 1, 3 and 6 months after treatment using the CP score classification. Patients were censored for toxicity after extensive tumor progression in the liver, new liver-directed therapies, or liver transplant. Time-to-events were calculated from date of SBRT. Results: A total of 22 patients were identified, but 3 were excluded for incomplete follow-up. Median follow-up time was 33 months (range: 11-95 months). At baseline, 13 (68%) patients had a CP score of 7, and 6 (32%) had a CP score of 8. The median PTV volume was 94 cc (range: 14-710 cc). The median prescribed dose was in 5 fractions (range: 35-45 Gy in 3-5 fractions). After SBRT, 8 (42%) patients presented with worsening in CP score, with a mean increase of 1.5 points (95% CI, 0.6-2.5; p = 0.005) at the first month of follow-up, but followed by recovery in liver function with change in CP score not statistically different from baseline at 3- or 6-month follow-up times (p = 0.35 and p = 0.13, respectively). Eight patients (42%) presented with acute hepatobiliary toxicity, with six of those presenting with ≥grade 2 toxicity. Patients with CP score change ≥2 points (n = 6) showed a significantly higher incidence of acute grade 2 or higher hepatobiliary toxicity (p = 0.001) with a trend toward worse overall survival (33 vs. 51 months, p = 0.45). Conclusions: In our cohort, SBRT demonstrated to be safe for patients with Child Pugh Class B liver function.

Application of stereotactic ablative radiotherapy in hepatocellular carcinoma patients with child–Turcotte–Pugh Class B liver function

2020 ◽  
Vol 0 (0) ◽  
pp. 0
Author(s):  
Chun-Shu Lin ◽  
Cheng-Hsiang Lo ◽  
Wen-Yen Huang ◽  
Wei-Chou Chang ◽  
Hsing-Lung Chao ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Function ◽  
Stereotactic Ablative Radiotherapy ◽  
Class B ◽  
Pugh Class

scholarly journals Potential of Lenvatinib for an Expanded Indication from the REFLECT Trial in Patients with Advanced Hepatocellular Carcinoma

Liver Cancer ◽  
2020 ◽  
Vol 9 (4) ◽  
pp. 382-396 ◽  
Author(s):  
Susumu Maruta ◽  
Sadahisa Ogasawara ◽  
Yoshihiko Ooka ◽  
Masamichi Obu ◽  
Masanori Inoue ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Function ◽  
Objective Response ◽  
Dose Intensity ◽  
Advanced Hepatocellular Carcinoma ◽  
First Line ◽  
High Burden ◽  
Advanced Hcc ◽  
Class B ◽  
Pugh Class

Background: The present study aimed to assess the efficacy and safety of lenvatinib and verify the possibility of lenvatinib for the expanded indication from the REFLECT trial in patients with advanced hepatocellular carcinoma (HCC) in real-world practice, primarily focusing on the population that was excluded in the REFLECT trial. Methods: We retrospectively collected data on patients with advanced HCC who were administered lenvatinib in 7 institutions in Japan. Results: Of 152 advanced HCC patients, 95 and 57 patients received lenvatinib in first-line and second- or later-line systemic therapies, respectively. The median progression-free survival in Child-Pugh class A patients was nearly equal between first- and second- or later-line therapies (5.2 months; 95% CI 3.7–6.9 for first line, 4.8 months; 95% CI 3.8–5.9 for second or later line, p = 0.933). According to the modified Response Evaluation Criteria in Solid Tumors, the objective response rate of 27 patients (18%) who showed a high burden of intrahepatic lesions (i.e., main portal vein and/or bile duct invasion or 50% or higher liver occupation) at baseline radiological assessment was 41% and similar with that of other population. The present study included 20 patients (13%) with Child-Pugh class B. These patients observed high frequency rates of liver function-related adverse events due to lenvatinib. The 8-week dose intensity of lenvatinib had a strong correlation with liver function according to both the Child-Pugh and albumin – bilirubin scores. Conclusion: Lenvatinib had potential benefits for patients with advanced HCC with second- or later-line therapies and a high burden of intrahepatic lesions. Dose modification should be paid increased attention among patients with poor liver function, such as Child-Pugh class B patients.

Sorafenib as bridging therapy in patients with intermediate hepatocellular carcinoma.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e14563-e14563
Author(s):  
Alessandro Vitale ◽  
Giuseppe Lombardi ◽  
Rafael Ramirez Morales ◽  
Sara Lonardi ◽  
Giacomo Zanus ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Tumour Progression ◽  
Performance Status ◽  
Intermediate Stage ◽  
Drop Out ◽  
Before And After ◽  
Secondary Endpoints ◽  
Modified Recist ◽  
Pugh Class ◽  
Bridge Therapy

e14563 Background: Patients with intermediate stage hepatocellular carcinoma (HCC) obtaining an unsatisfactory response after loco regional (LR) therapies are at high risk of drop-out from a new chance of LR treatment or progression to advanced-terminal stages of disease. We prospectively used Sorafenib in this particular category of patients as a bridge therapy. The aim was to decrease the risk of tumour progression and to make them again eligible for loco regional therapies. Methods: Primary endpoint: disease control (DC) with Sorafenib, defined as complete/partial response or stable disease as by the modified RECIST criteria, maintained for ≥ 28 days from the first indications of response. Secondary endpoints: proportion of patients progression free at 2 months; median overall and progression free survivals. Patients obtaining DC with Sorafenib were again considered eligible for LR therapy. Inclusion criteria: a) intermediate stage; b) Child Pugh class A; c) performance status 0; d) unsatisfactory response to LR therapies (resection, ablation, chemoembolization), defined as incomplete response after at least 2 LR therapies. Study period: 01/04/2008–31/10/2011. End of follow-up: 31/01/2012. Results: Forty one patients were enrolled according to the study design. Thirty seven patients (90%) were progression free at the 2 months evaluation. A persistent DC was obtained in 29 patients (71%). According to the study hypothesis these patients were considered again eligible for loco regional therapies: 19 patients (65%) had ablation ± chemoembolization; 6 had liver transplantation (22%); 3 had liver resection (13%); 1 had radioembolization. Median duration of therapy with Sorafenib was 5 months (1–22). Sixteen patients (55%) had Sorafenib therapy both before and after LR therapy. Fourteen patients (48%) had more than one LR procedure. Median survival was 21 months (range, 1–39) in the whole group, while it was 25 months (range, 2–39) in the DC subgroup (median time to progression = 21 months, range 2–39). Conclusions: Sorafenib achieves high DC rates in BCLC B HCC patients with unsatisfactory response to LR therapies making them again eligible for LR therapies.

Sign in / Sign up

Export Citation Format

Share Document