Atsushi Hiraoka1, Takashi Kumada2, Masanori Atsukawa3, Masashi Hirooka4, Kunihiko Tsuji5, Toru Ishikawa6, Koichi Takaguchi7, Kazuya Kariyama8, Ei Itobayashi9, Kazuto Tajiri10, Noritomo Shimada11, Hiroshi Shibata12, Hironori Ochi13, Toshifumi Tada2, Hidenori Toyoda2, Kazuhiro Nouso8, Akemi Tsutsui7, Takuya Nagano7, Norio Itokawa5, Korenobu Hayama5, Michitaka Imai6, Kouji Joko13, Yohei Koizumi4, Yoichi Hiasa4, Kojiro Michitaka14. 1. Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan, hirage@m.ehime-u.ac.jp. 2. Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Gifu, Japan. 3. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Nippon Medical School, Tokyo, Japan. 4. Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Ehime, Japan. 5. Gastroenterology Center, Teine Keijinkai Hospital, Sapporo, Japan. 6. Department of Gastroenterology, Saiseikai Niigata Hospital, Niigata, Japan. 7. Department of Hepatology, Kagawa Prefectural Central Hospital, Takamatsu, Japan. 8. Department of Gastroenterology, Okayama City Hospital, Okayama, Japan. 9. Department of Gastroenterology, Asahi General Hospital, Asahi, Japan. 10. Department of Gastroenterology, Toyama University Hospital, Toyama, Japan. 11. Division of Gastroenterology and Hepatology, Otakanomori Hospital, Kashiwa, Japan. 12. Department of Gastroenterology, Tokushima Prefectural Central Hospital, Tokushima, Japan. 13. Hepato-Biliary Center, Matsuyama Red Cross Hospital, Matsuyama, Japan. 14. Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan.
Abstract
BACKGROUND/AIM: Lenvatinib (LEN) has been developed for the treatment of unresectable hepatocellular carcinoma (u-HCC). We aimed to elucidate the relative change in hepatic reserve function early following LEN treatment in affected patients. MATERIALS/ METHODS: From March 2018 to April 2019, 123 u-HCC patients (median age 71 years; male:female ratio 95:28; Child-Pugh score 5:6:7 = 65:50:8; modified albumin-bilirubin [mALBI] grade 1:2a:2b:3 = 44:28:50:1, Barcelona Clinic Liver Cancer stage A:B:C = 1:49:73) were enrolled. Relative changes in hepatic reserve function at 2 and 4 weeks after starting LEN were retrospectively evaluated. RESULTS: The median survival was 11.3 months. The Child-Pugh score declined from the start to 4 weeks after commencing LEN (score 5:6:7:8:9:≥10 = 65:50:8:0:0:0 vs. 50:39:22:8:0:4, p < 0.001). A comparison among ALBI scores at the start of LEN and those at 2 and 4 weeks revealed significant relative changes (-2.36 ± 0.45 to -2.20 ± 0.49 at 2 weeks, -2.15 ± 0.50 at 4 weeks, p < 0.001, Bonferroni method), while there was no significant difference between those at 2 and 4 weeks (p= 0.210, Bonferroni method). Assessments of relative changes of ALBI score in patients divided by mALBI grade 1, 2a, and 2b or more showed a significant decline in score regardless of grade (-2.82 ± 0.17 to -2.53 ± 0.34, p < 0.001; -2.46 ± 0.10 to -2.31 ± 0.33, p = 0.017; and -1.90 ± 0.26 to -1.75 ± 0.42, p= 0.009, respectively). CONCLUSION: Decline in hepatic function is common in the early stage (≤4 weeks, especially within 2 weeks) after introducing LEN. It is important to introduce molecular targeting agent drugs for u-HCC in patients with better hepatic function, who show transarterial catheter chemoembolization failure, as much as possible, along with consideration of the negative influence of LEN on the early response of hepatic function.
BACKGROUND/AIM: Lenvatinib (LEN) has been developed for the treatment of unresectable hepatocellular carcinoma (u-HCC). We aimed to elucidate the relative change in hepatic reserve function early following LEN treatment in affected patients. MATERIALS/ METHODS: From March 2018 to April 2019, 123 u-HCC patients (median age 71 years; male:female ratio 95:28; Child-Pugh score 5:6:7 = 65:50:8; modified albumin-bilirubin [mALBI] grade 1:2a:2b:3 = 44:28:50:1, Barcelona Clinic Liver Cancer stage A:B:C = 1:49:73) were enrolled. Relative changes in hepatic reserve function at 2 and 4 weeks after starting LEN were retrospectively evaluated. RESULTS: The median survival was 11.3 months. The Child-Pugh score declined from the start to 4 weeks after commencing LEN (score 5:6:7:8:9:≥10 = 65:50:8:0:0:0 vs. 50:39:22:8:0:4, p < 0.001). A comparison among ALBI scores at the start of LEN and those at 2 and 4 weeks revealed significant relative changes (-2.36 ± 0.45 to -2.20 ± 0.49 at 2 weeks, -2.15 ± 0.50 at 4 weeks, p < 0.001, Bonferroni method), while there was no significant difference between those at 2 and 4 weeks (p= 0.210, Bonferroni method). Assessments of relative changes of ALBI score in patients divided by mALBI grade 1, 2a, and 2b or more showed a significant decline in score regardless of grade (-2.82 ± 0.17 to -2.53 ± 0.34, p < 0.001; -2.46 ± 0.10 to -2.31 ± 0.33, p = 0.017; and -1.90 ± 0.26 to -1.75 ± 0.42, p= 0.009, respectively). CONCLUSION: Decline in hepatic function is common in the early stage (≤4 weeks, especially within 2 weeks) after introducing LEN. It is important to introduce molecular targeting agent drugs for u-HCC in patients with better hepatic function, who show transarterial catheter chemoembolization failure, as much as possible, along with consideration of the negative influence of LEN on the early response of hepatic function.
Authors: Na Ryung Choi; Ju Yeon Kim; Ji Hoon Hong; Moon Haeng Hur; Heejin Cho; Min Kyung Park; Jihye Kim; Yun Bin Lee; Eun Ju Cho; Jeong-Hoon Lee; Su Jong Yu; Jung-Hwan Yoon; Yoon Jun Kim Journal: BMC Gastroenterol Date: 2022-03-25 Impact factor: 3.067