Toru  Ishikawa,Saori  Endo,Michitaka  Imai,Motoi  Azumi,Yujiro  Nozawa,Tomoe  Sano,Akito  Iwanaga,Terasu  Honma,Toshiaki  Yoshida,
Additional Treatment Using Transcatheter Arterial Infusion with Drug-Eluting Beads Transarterial Chemoembolization Contributes to Prolonged Survival of Patients with BCLC Stage C Hepatocellular Carcinoma after Discontinuing Lenvatinib: Preliminary Study
Clinical Oncology and Research
2020
2613-4942
http://dx.doi.org/10.31487/j.COR.2020.08.28
https://www.sciencerepository.org/additional-treatment-using-transcatheter-arterial-infusion-with-drug-eluting_COR-2020-8-128 
Abstract: Objective: Lenvatinib is considered the first-line treatment for unresectable advanced hepatocellular
carcinoma (HCC); however, in some clinical cases, discontinuation of lenvatinib is unavoidable. It is
important to elucidate if transcatheter arterial infusion (TAI) with drug-eluting beads transarterial
chemoembolization (DEB-TACE) is a feasible second-line treatment after discontinuing lenvatinib. In this
study, we aimed to evaluate the efficacy, hepatic function and nutritional status associated with TAI with
DEB-TACE for patients who previously discontinued lenvatinib.
Materials and Methods: We included 35 patients who were prescribed lenvatinib for unresectable HCC
between July 2018 and December 2019, of whom 12 discontinued lenvatinib during the study. The changes
in the albumin-bilirubin (ALBI) score and the controlling nutritional status (CONUT) score before and after
discontinuing lenvatinib were examined. Furthermore, the tolerability and survival of patients treated using
TAI with DEB-TACE as a second-line treatment were analysed.
Results: The ALBI and CONUT scores were significantly worse when lenvatinib was started and stopped
(p<0.05). The CONUT score was significantly worse in the second-line group than in the follow-up group
when beginning and discontinuing lenvatinib; however, this score tended to improve after DEB-TACE. The
group that underwent TAI with DEB-TACE as a second-line treatment had significantly better survival than
the follow-up group (log‑rank test, p=0.029; generalized Wilcoxon test, p=0.042).
Conclusion: In patients who could undergo TAI with DEB-TACE as a second-line treatment after
discontinuing lenvatinib, the CONUT score improved, while the ALBI score was maintained and welltolerated; these scores may have contributed to improved survival compared with follow-up patients. Future
studies with larger sample sizes are necessary to confirm our findings.Keywords: Hepatocellular carcinoma, lenvatinib, transcatheter arterial infusion, drug-eluting beads transarterial, chemoembolization, controlling nutritional status score, albumin-bilirubin (ALBI) score