In:
Liver Cancer, S. Karger AG, Vol. 10, No. 2 ( 2021), p. 115-125
Abstract:
〈 b 〉 〈 i 〉 Background/Aim: 〈 /i 〉 〈 /b 〉 An effective postprogression treatment of lenvatinib (LEN) against unresectable hepatocellular carcinoma (u-HCC) has not been established. We aimed to elucidate the clinical role of continuing LEN beyond progression of disease (PD). 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 From March 2018 to October 2020, 99 u-HCC patients, in whom PD was confirmed (male:female = 78:21, median age 72 years, Child-Pugh A = 99, Barcelona Clinic Liver Cancer stage A:B:C = 2:43:54, LEN as first-line = 55), were enrolled (stopped LEN at PD [A group], 〈 i 〉 n 〈 /i 〉 = 26; continued LEN beyond PD [B group], 〈 i 〉 n 〈 /i 〉 = 73). Radiological response was evaluated with RECIST 1.1. Clinical features and prognostic factors for overall survival (OS) were retrospectively investigated using inverse probability weighting (IPW) calculated by propensity score. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Median time to progression, best response, and modified albumin-bilirubin grade (mALBI) at both baseline and PD did not show significant difference between the groups. Postprogression treatment in the A group was best supportive care in 17, sorafenib in 4, regorafenib in 3, ramucirumab in 1, and hepatic arterial infusion chemotherapy in 1. After adjusting with IPW, the B group showed better prognosis in regard to OS after PD and OS after introducing LEN than the A group (10.8/19.6 vs. 5.8/11.2 months, 〈 i 〉 p 〈 /i 〉 & #x3c; 0.001, respectively). In IPW-adjusted Cox hazard multivariate analysis, significant prognostic factors for OS after PD were mALBI 2b/3 at PD (HR 1.983, 〈 i 〉 p 〈 /i 〉 = 0.021), decline of Eastern Cooperative Oncology Group performance status (ECOG PS) from baseline at PD (HR 3.180, 〈 i 〉 p 〈 /i 〉 & #x3c; 0.001), elevated alpha-fetoprotein (≥100 ng/mL) at introducing LEN (HR 2.511, 〈 i 〉 p 〈 /i 〉 = 0.004), appearance of new extrahepatic metastasis (HR 2.396, 〈 i 〉 p 〈 /i 〉 = 0.006), positive for hand-foot skin reaction (HFSR) before PD (any grade) (HR 0.292, 〈 i 〉 p 〈 /i 〉 & #x3c; 0.001), and continuing LEN beyond PD (HR 0.297, 〈 i 〉 p 〈 /i 〉 & #x3c; 0.001). 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 When ECOG PS and hepatic reserve function permit, continuing LEN treatment beyond PD, especially in u-HCC patients showed HFSR during LEN treatment, might be a good therapeutic option, at least until a more effective drug as a postprogression treatment after LEN failure is developed.
Type of Medium:
Online Resource
ISSN:
2235-1795
,
1664-5553
Language:
English
Publisher:
S. Karger AG
Publication Date:
2021
detail.hit.zdb_id:
2666925-0
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