Journal
CLINICAL JOURNAL OF GASTROENTEROLOGY
Volume 16, Issue 3, Pages 438-443Publisher
SPRINGER JAPAN KK
DOI: 10.1007/s12328-023-01777-y
Keywords
Lenvatinib; Hepatocellular carcinoma; LEN-TACE
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The efficacy of LEN-TACE in unresectable hepatocellular carcinoma (HCC) refractory to LEN therapy is demonstrated in a case report. The patient had multiple HCCs and was initially treated with TACE, but developed resistance to it and subsequent molecular-targeted agents (MTA). LEN-TACE was attempted as salvage therapy and showed significant reduction in tumor markers and complete response according to RECIST guidelines. LEN-TACE may be a last-line treatment option for unresectable advanced HCC refractory to LEN therapy.
The efficacy of lenvatinib (LEN) plus transcatheter arterial chemoembolization (LEN-TACE) has been reported, but its effect on unresectable hepatocellular carcinoma (HCC) refractory to LEN therapy has not been demonstrated. We report a case of HCC refractory to multiple molecular-targeted agents (MTA) treatments, including LEN, that was successfully treated with LEN-TACE. A 59-year-old man was referred to our department with multiple HCCs and a background of hepatitis B virus infection. TACE was the initial treatment. However, he was determined to be TACE-refractory, and multitargeted therapy was initiated. LEN was started at 12 mg/day but resulted in progressive disease (PD) after 13 months of the administration. The response to second-line sorafenib was PD after 2 months. Third-line therapy with atezolizumab + bevacizumab was stopped after one course because of an immune-related adverse event (i.e., dermatitis). The response to fourth-line regorafenib was PD at 2 months, and the response to fifth-line cabozantinib was PD after 6 months. The efficacy of LEN-TACE was recently reported; therefore, we decided to attempt LEN-TACE therapy as a salvage line. After obtaining the patient's consent to repeat LEN and TACE, treatment was initiated. The tumor markers levels markedly reduced after LEN-TACE therapy. After three additional TACE treatments with continued LEN administration, the tumor marker levels normalized, and complete response was determined based on RECIST guidelines. LEN-TACE therapy may effectively treat unresectable advanced HCC in the LEN-rechallenge setting and may be a treatment option as a last-line therapeutic option.
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