Introduction: Multidisciplinary treatment is widely applied for advanced hepatocellular carcinoma (HCC). Systemic therapy is recommended and can provide a modest prognosis for HCC in Barcelona Clinic Liver Cancer staging C. Lenvatinib is a newly developed multityrosine kinase inhibitor and has become a more preferred targeted drug than sorafenib to achieve conversion surgery due to its higher tumor necrosis effect. To our best knowledge, we have published 1st report of HCC patient undergoing conversion hepatectomy by multidisciplinary treatment including lenvatinib in October 2019.
Methods: Literature review was conducted of PubMed in recent 10 years. Keywords included lenvatinib, hepatocellular carcinoma, conversion therapy, and conversion surgery.
Results: Based on a randomized controlled phase-III REFLECT trial, the overall response rate was higher for lenvatinib than for sorafenib (41% vs. 12% assessed by modified Response Evaluation Criteria in Solid Tumors). Recently, a greater response rate of 45% was demonstrated in patients treated with lenvatinib in combination with pembrolizumab. Seven patients have been published treated with conversion surgery after multidisciplinary treatment including lenvatinib. All patients were judged as a partial response so that good tumor response was thought to be essential for conversion surgery. We have demonstrated the most impressive patient treated by ourselves. The patient had two huge HCCs, 24 cm in maximal diameter, with an excessive arterioportal shunt together with impaired liver function and extremely high level of the alpha-fetoprotein (1,008,021 ng/mL). She was treated with 4 times of transarterial chemoembolization and lenvatinib therapy followed by extended right hepatectomy. Her general condition is stable with no recurrences, 27 months after the initial therapy. The most important phenomena included the complete disappearance of remarkable arterioportal shunt followed by improvement of liver function.
Conclusions: Lenvatinib therapy is one of the quite beneficial options of conversion therapy for unresectable HCC.
Arterioportal shunt, Conversion therapy, Conversion surgery, Hepatectomy, Hepatocellular carcinoma, Lenvatinib therapy