Hatanaka Takeshi, Naganuma Atsushi, Kakizaki Satoru
Department of Gastroenterology, Gunma Saiseikai Maebashi Hospital, 564-1 Kamishindenmachi, Maebashi, Gunma 371-0821, Japan.
Department of Gastroenterology, National Hospital Organization Takasaki General Medical Center, 36 Takamatsucho, Takasaki, Gunma 370-0829, Japan.
Pharmaceuticals (Basel). 2021 Jan 6;14(1):36. doi: 10.3390/ph14010036.
Lenvatinib, which is an oral multikinase inhibitor, showed non-inferiority to the sorafenib in terms of overall survival (OS) and a higher objective response rate (ORR) and better progression-free survival (PFS) in patients with hepatocellular carcinoma (HCC). A good liver function and Barcelona Clinic Liver Cancer (BCLC) intermediate stage were the key factors in achieving therapeutic efficacy. The management of adverse events plays an important role in continuing lenvatinib treatment. While sequential therapies contributed to prolonging overall survival, effective molecular targeted agents for the administration after lenvatinib have not been established. Repeated transcatheter arterial chemoembolization (TACE) was associated with a decline in the liver function and poor therapeutic response in BCLC intermediate patients. Recently, the Asia-Pacific Primary Liver Cancer Expert (APPLE) Consensus Statement proposed the criteria for TACE unsuitability. Upfront systemic therapy may be better for the BCLC intermediate stage HCC patients with a high tumor burden, while selective TACE will be recommended for obtaining a curative response in patients with a low tumor burden. This article reviews the therapeutic response, management of adverse events, post-progression treatment after Lenvatinib, and treatment strategy for BCLC intermediate stage HCC.
仑伐替尼是一种口服多激酶抑制剂，在肝细胞癌（HCC）患者的总生存期（OS）方面显示出不劣于索拉非尼，且客观缓解率（ORR）更高，无进展生存期（PFS）更好。良好的肝功能和巴塞罗那临床肝癌（BCLC）中期是实现治疗效果的关键因素。不良事件的管理在继续使用仑伐替尼治疗中起着重要作用。虽然序贯疗法有助于延长总生存期，但尚未确立仑伐替尼治疗后有效的分子靶向给药方案。重复经动脉化疗栓塞术（TACE）与BCLC中期患者肝功能下降和治疗反应不佳有关。最近，亚太原发性肝癌专家（APPLE）共识声明提出了TACE不适用的标准。对于肿瘤负荷高的BCLC中期HCC患者， upfront全身治疗可能更好，而对于肿瘤负荷低的患者，推荐选择性TACE以获得治愈性反应。本文综述了仑伐替尼治疗反应、不良事件管理、仑伐替尼治疗后进展期治疗以及BCLC中期HCC的治疗策略。
