In:
Liver Cancer, S. Karger AG, Vol. 9, No. 6 ( 2020), p. 756-770
Abstract:
〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 The aims of this study were to evaluate the efficacy of additional treatment, especially lenvatinib-transarterial chemoembolization (TACE) sequential therapy, for unresectable hepatocellular carcinoma (HCC). 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 Consecutive 56 patients who underwent lenvatinib treatment were reviewed. Oncological aggressiveness of tumor was estimated using a dynamic CT enhancement pattern classification, and clinical impact of subsequent treatment was investigated through analysis of progression-free survival (PFS), post-progression survival (PPS), and multivariate analysis of potential confounders for survival after progression during lenvatinib therapy. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Heterogeneous enhancement patterns ( 〈 i 〉 Type-3 〈 /i 〉 and 〈 i 〉 -4 〈 /i 〉 ), which are reportedly associated with higher oncological aggressiveness of HCC, were associated with better objective response to lenvatinib compared to homogeneous enhancement pattern ( 〈 i 〉 Type-2 〈 /i 〉 ) (86 and 85% vs. 53% in modified Response Evaluation Criteria in Solid Tumors), resulting in similar PFS ( 〈 i 〉 p 〈 /i 〉 = 0.313). Because of significantly worse PPS, overall survival of 〈 i 〉 Type-4 〈 /i 〉 tumor was poor compared to 〈 i 〉 Type-2 〈 /i 〉 or 〈 i 〉 -3 〈 /i 〉 tumors ( 〈 i 〉 p 〈 /i 〉 = 0.009). However, subgroup of patients who achieved subsequent treatment showed significantly better PPS, regardless of CT enhancement pattern. Multivariate analysis confirmed that use of lenvatinib-TACE sequential treatment after progression during lenvatinib therapy was associated with better PPS (hazard ratio [HR], 0.08; 95% CI, 0.01–0.71; 〈 i 〉 p 〈 /i 〉 = 0.023), while 〈 i 〉 Type-4 〈 /i 〉 enhancement pattern was correlated with worse PPS (HR, 2.92; 95% CI, 1.06–8.05; 〈 i 〉 p 〈 /i 〉 = 0.039). 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 Oncological aggressiveness of HCC estimated by CT enhancement pattern was predictive of PPS after progression during lenvatinib. Successful subsequent treatment with lenvatinib-TACE sequential therapy may offer survival benefit regardless of CT enhancement pattern of HCC.
Type of Medium:
Online Resource
ISSN:
2235-1795
,
1664-5553
Language:
English
Publisher:
S. Karger AG
Publication Date:
2020
detail.hit.zdb_id:
2666925-0
Permalink