Post-Progression Treatment Eligibility of Unresectable Hepatocellular Carcinoma Patients Treated with Lenvatinib.

Child-Pugh class Hepatocellular carcinoma Lenvatinib Modified albumin-bilirubin grade Ramucirumab

Journal

Liver cancer

ISSN: 2235-1795

Titre abrégé: Liver Cancer

Pays: Switzerland

ID NLM: 101597993

Informations de publication

Date de publication:
Jan 2020

Historique:

received: 17 07 2019

accepted: 28 08 2019

entrez: 20 2 2020

pubmed: 20 2 2020

medline: 20 2 2020

Statut: ppublish

Résumé

Post-progression treatment following tyrosine-kinase inhibitor (TKI) failure in patients with unresectable hepatocellular carcinoma (u-HCC) is important to prolong post-progression survival (PPS), which has a good correlation with overall survival (OS). This study aimed to elucidate the clinical features of progressive disease (PD) in patients treated with lenvatinib (LEN). From March 2018 to June 2019, 156 u-HCC patients with Child-Pugh A were enrolled (median age: 71 years, Child-Pugh score 5:6 = 105:51, BCLC A:B:C = 8:56:92, modified albumin-bilirubin grade (mALBI) 1:2a:2b = 59:42:55, past history of sorafenib:regorafenib = 57:17). Clinical features were retrospectively evaluated. The median observation period was 8.5 months. Median OS was not obtained, while median time to decline to Child-Pugh B (CPB) was 11.4 months, median time to progression (TTP) was 8.4 months, and the period of LEN administration was 7.3 months. When we compared predictive values for time to decline to CPB based on Child-Pugh score and mALBI, values for Akaike information criterion (AIC) score and c-index of mALBI were superior as compared to Child-Pugh score (AIC: 592.3 vs. 599.7) (c-index: 0.655 vs. 0.597). Of the 73 patients with PD, 32 (43.8%) showed no decline to CPB or death. After excluding 3 without alpha-fetoprotein data at PD determination, only 14 (20.0%) of 70 showed REACH-2 eligibility. Non-mALBI 1/2a at the start of LEN was a significant risk factor for decline to CPB during LEN treatment (HR 2.552, 95% CI: 1.577-4.129; Introduction of TKI therapy including LEN for u-HCC patients with better hepatic function (mALBI 1/2a: ALBI score ≤-2.27), when possible, increases the chance of undergoing post-progression treatment, which can improve PPS.

Sections du résumé

BACKGROUND/AIM OBJECTIVE

MATERIALS/METHODS METHODS

From March 2018 to June 2019, 156 u-HCC patients with Child-Pugh A were enrolled (median age: 71 years, Child-Pugh score 5:6 = 105:51, BCLC A:B:C = 8:56:92, modified albumin-bilirubin grade (mALBI) 1:2a:2b = 59:42:55, past history of sorafenib:regorafenib = 57:17). Clinical features were retrospectively evaluated.

RESULTS RESULTS

The median observation period was 8.5 months. Median OS was not obtained, while median time to decline to Child-Pugh B (CPB) was 11.4 months, median time to progression (TTP) was 8.4 months, and the period of LEN administration was 7.3 months. When we compared predictive values for time to decline to CPB based on Child-Pugh score and mALBI, values for Akaike information criterion (AIC) score and c-index of mALBI were superior as compared to Child-Pugh score (AIC: 592.3 vs. 599.7) (c-index: 0.655 vs. 0.597). Of the 73 patients with PD, 32 (43.8%) showed no decline to CPB or death. After excluding 3 without alpha-fetoprotein data at PD determination, only 14 (20.0%) of 70 showed REACH-2 eligibility. Non-mALBI 1/2a at the start of LEN was a significant risk factor for decline to CPB during LEN treatment (HR 2.552, 95% CI: 1.577-4.129;

CONCLUSION CONCLUSIONS

Introduction of TKI therapy including LEN for u-HCC patients with better hepatic function (mALBI 1/2a: ALBI score ≤-2.27), when possible, increases the chance of undergoing post-progression treatment, which can improve PPS.

Identifiants

DOI: 10.1159/000503031 PMID: 32071911 PMC: PMC7024896

pubmed: 32071911

doi: 10.1159/000503031

pii: lic-0009-0073

pmc: PMC7024896

doi:

Types de publication

Journal Article

Langues

eng

Pagination

73-83

Informations de copyright

Déclaration de conflit d'intérêts

Conflicts of interest of Dr. Takashi Kumada (2018): lecture − Eisai. Conflicts of interest of Prof. Masatoshi Kudo, MD, PhD (2018): lecture − Bayer, Eisai, MSD; grant − EA Pharma, Eisai, Gilead, Takeda, Otsuka, Taiho; advisory consulting − Eisai, Ono, MSD, BMS. Conflicts of interest of Dr. Koichi Takaguchi (2018): lecture − AbbVie.

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