Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan.
Department of Community Medicine for Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, 2-50-1, Kuramoto, Tokushima, Tokushima, 770042, Japan.
Clin J Gastroenterol. 2023 Jun;16(3):438-443. doi: 10.1007/s12328-023-01777-y. Epub 2023 Mar 1.
The efficacy of lenvatinib (LEN) plus transcatheter arterial chemoembolization (LEN-TACE) has been reported, but its effect on unresectable hepatocellular carcinoma (HCC) refractory to LEN therapy has not been demonstrated. We report a case of HCC refractory to multiple molecular-targeted agents (MTA) treatments, including LEN, that was successfully treated with LEN-TACE. A 59-year-old man was referred to our department with multiple HCCs and a background of hepatitis B virus infection. TACE was the initial treatment. However, he was determined to be TACE-refractory, and multitargeted therapy was initiated. LEN was started at 12 mg/day but resulted in progressive disease (PD) after 13 months of the administration. The response to second-line sorafenib was PD after 2 months. Third-line therapy with atezolizumab + bevacizumab was stopped after one course because of an immune-related adverse event (i.e., dermatitis). The response to fourth-line regorafenib was PD at 2 months, and the response to fifth-line cabozantinib was PD after 6 months. The efficacy of LEN-TACE was recently reported; therefore, we decided to attempt LEN-TACE therapy as a salvage line. After obtaining the patient's consent to repeat LEN and TACE, treatment was initiated. The tumor markers levels markedly reduced after LEN-TACE therapy. After three additional TACE treatments with continued LEN administration, the tumor marker levels normalized, and complete response was determined based on RECIST guidelines. LEN-TACE therapy may effectively treat unresectable advanced HCC in the LEN-rechallenge setting and may be a treatment option as a last-line therapeutic option.
仑伐替尼（LEN）联合经导管肝动脉化疗栓塞术（LEN-TACE）的疗效已有报道，但尚未证实其对LEN 治疗耐药的不可切除肝细胞癌（HCC）的疗效。我们报告了一例仑伐替尼耐药的不可切除 HCC 病例，该病例通过 LEN-TACE 成功治疗。一名 59 岁男性因患有乙型肝炎病毒感染相关的多个 HCC 而被转诊至我科。TACE 是初始治疗方法。然而，他被确定为 TACE 耐药，随后开始了多靶点治疗。LEN 起始剂量为 12mg/天，但在给药 13 个月后出现疾病进展（PD）。二线索拉非尼治疗 2 个月后也出现 PD。由于免疫相关不良事件（即皮炎），三线治疗阿特珠单抗+贝伐珠单抗仅进行了一个疗程即停止。四线regorafenib 治疗 2 个月后 PD，五线卡博替尼治疗 6 个月后 PD。LEN-TACE 的疗效最近有报道；因此，我们决定尝试将 LEN-TACE 治疗作为挽救性治疗方案。在获得患者重复使用 LEN 和 TACE 的同意后，开始治疗。LEN-TACE 治疗后肿瘤标志物水平显著降低。在继续使用 LEN 进行三次额外的 TACE 治疗后，肿瘤标志物水平正常化，根据 RECIST 指南确定完全缓解。LEN-TACE 治疗可能有效治疗 LEN 再挑战背景下不可切除的晚期 HCC，并且可能是作为最后一线治疗选择的一种治疗方案。
