Objective To explore the opportunity of surgery after transarterial chemoembolization therapy for patient with primary hepatocellular carcinoma in Barcelona Clinic Liver Cancer (BCLC) B stage. Methods Multi- disciplinary team (MDT) carried out for a BCLC B stage patient in October 2017 in the Second Affiliated Hospital of Chongqing Medical University. The patient diagnosed with massive primary hepatocellular carcinoma in right lobe of the liver accompanied by para-tumor satellite nodules and metastatic nodules in quadrate lobe (BCLC B stage) in 2 months ago and received twice TACE therapies in the first 2 months. The MDT group developed anterior approach in right hepatectomy and tumor enucleation in the left medial segment. Results The experts group of MDT agreed on the patient undergone twice TACE therapies, whose tumor in right lobe had shrinked and left lobe enlarged, and the patient acquired the opportunity for surgery. By elaborately devised perioperative care and surgery risk control, the patient undergone operation successfully and recovered without any operative complications. Conclusions A proportion of BCLC B stage patients with hepatocellular carcinoma can acquire the opportunity of a second stage operation for removal of the tumor. We should manage this portion of patients well and strive for the best therapeutic effect.
ObjectiveTo explore the safety and effectiveness of transarterial chemoembolization (TACE) combined with lenvatinib and programmed cell death protein-1 (PD-1) antibody in the conversion resection for intermediate and advanced unresectable hepatocellular carcinoma (HCC), and to provide new treatment strategies for the treatment of intermediate and advanced unresectable HCC. MethodThirty-eight intermediate and advanced unresectable HCC patients treated at West China Hospital of Sichuan University from October 2020 to June 2021 were prospectively included in our study, all patients treated with TACE + lenvatinib + PD-1 antibody, and the clinical data of these 38 patients were summarized. ResultsThe last evaluation time for the 38 patients was October 20, 2021. According to the mRECIST standard for tumor efficacy evaluation, the objective response rate was 84.2% (32/38), the disease control rate was 94.7% (36/38); the conversion success rate based on imaging was 55.3% (21/38), the actual conversion resection rate was 52.6% (20/38). The incidence of adverse events was 100%, of which 22 patients had grade 3 adverse events, and there was no ≥ grade 4 adverse events. All patients were followed up, the follow-up time was 16–52 weeks, and the median follow-up time was 33.5 weeks. During the follow-up period, only two patients had tumor progression, of which one patient died due to disease progression, and there was no postoperative recurrence. ConclusionsLenvatinib combined with TACE and PD-1 antibody is safe for the treatment of intermediate and advanced unresectable HCC. Triple therapy can achieve satisfactory conversion resection rate of intermediate and advanced unresectable HCC, which will provide a new treatment strategy for it.
Objective To summarize the effect of lenvatinib + transarterial chemoembolization (TACE) + programmed cell death protein-1 (PD-1) antibody in the treatment of hepatocellular carcinoma with main portal vein tumor thrombus and cavernous transformation. Methods In this study, we reported the clinical data of four patients with hepatocellular carcinoma with main portal vein tumor thrombus and cavernous transformation who received conversion therapy with lenvatinib combined with TACE and PD-1 antibody in West China Hospital. Results Among the four patients, two patients achieved complete response and two achieved partial response; tumor markers were significantly decreased after combination treatment. However, all four patients failed to undergo hepatectomy. ConclusionsLenvatinib + TACE + PD-1 antibody is effective for hepatocellular carcinoma with main portal vein tumor thrombus and cavernous transformation. However, there are still many problems worthy of further discussion.
Objective To explore the safety and efficacy of lenvatinib in combination with transarterial chemoembolization (TACE) and programmed death receptor 1 (PD-1) antibody in the treatment of recurrent liver cancer. Method The clinical data of 22 patients with unresectable recurrent liver cancer admitted to Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University and received the conversion therapy of lenvatinib+TACE+PD-1 antibody between January 2019 and January 2022 were retrospectively analyzed. Results All 22 patients experienced some degree of adverse events, with a grade 3 adverse event rate of 18.2% (4/22) and no grade 4 or higher adverse events. At 4 months of treatment, according to the modified response evaluation criteria solid tumors (mRECIST), 2 cases were in complete response (CR), 5 cases were in partial response (PR), and 6 cases were in stable disease (SD), 9 cases were in progressive disease (PD), and the objective response (CR+PR) rate (ORR) was 31.8% (7/22). At the last follow-up, there was 1 case in CR, 5 cases in PR, 1 case in SD, and 15 cases in PD, with an ORR of 27.3% (6/22). The 1-year overall survival (OS) rate was 83.8% and the 1-year progression-free survival (PFS) rate was 38.2%. In the subgroup analysis, the 1-year OS rate for patients with recurrent liver cancer with intrahepatic lesions (n=16) only was 86.2% [95%CI (77.1%, 95.3%)], the 1-year PFS rate was 46.9% [95%CI (34.0%, 59.8%)], and the ORR based on mRECIST criteria was 43.8% (7/16). Patients with intrahepatic combined with extrahepatic lesions (n=6) had a 1-year OS rate of 75.0% [95%CI (53.3%, 96.7%)] and a 1-year PFS rate of 16.7% [95%CI (15.0%, 31.9%)], and the ORR based on mRECIST criteria was 0% (0/6). There were no significant differences in OS (P=0.864) and PFS (P=0.125) between the two subgroups. The ORR of intrahepatic combined with extrahepatic lesions group was worse compared to the intrahepatic lesion group (P=0.049). Conclusion Lenvatinib in combination with TACE and PD-1 antibody is safe and effective in the treatment of unresectable recurrent liver cancer, but there are still many issues that deserve further exploration.
ObjectiveTo investigate the effects of lenvatinib combined with transarterial chemoembolization (TACE) and programmed death protein-1 (PD-1) monoclonal antibody (Abbreviated as LEN-TAP regimen) on residual liver volume and surgical safety in intermediate and advanced hepatocellular carcinoma (HCC). MethodsThe clinicopathologic data of patients with intermediate and advanced HCC were collected retrospectively, who underwent the LEN-TAP conversion therapy and surgical resection in the Department of Liver Surgery, West China Hospital, Sichuan University from October 2020 to December 2021. The total liver volume, tumor volume, and residual liver volume of the patients before and after conversion therapy were analyzed. ResultsA total of 48 patients were included, 26 of whom had partial remission and 22 had stable disease, the objective response rate was 54.2% (26/48) according to the Response Evaluation Criteria in Solid Tumours 1.1 after conversion therapy. Before and after conversion therapy, the total liver volumes including tumor were (1 607.15±712.22) mL and (1 558.03±573.89) mL [mean difference (MD) and 95% confidence interval (CI)=–57.42(–134.30, 19.46), t=–1.503, P=0.140], the total liver volumes excluding tumor tissue were (1 095.28±227.60) mL and (1 260.31±270.71) mL [MD(95%CI)=165.03(128.13, 201.93), t=8.997, P<0.001], the tumor volumes were 260.25(107.75, 699.50) mL and 121.73 (33.00, 332.88) mL [MD(95%CI)=–222.45(–296.46, –148.44), Z=–5.641, P<0.001], and the residual liver volumes were (493.62±154.51) mL and (567.83±172.23) mL [MD(95%CI)=74.21(54.64, 93.79), t=7.627, P<0.001], respectively. The increase rates of tumor volume and residual liver volume after conversion therapy were (–53.34±33.05)% and (16.34±15.16)%, respectively. The conversional resections were successfully completed in all patients, with 13 (27.1%) cases experiencing postoperative complications and without occurrence of postoperative liver failure. ConclusionThe data analysis results of this study indicate that the LEN-TAP conversion therapy can shrink tumor volume and increase the residual liver volume for patients with intermediate and advanced HCC, which helps to improve the safety of conversion resection.