Conversion therapy for unresectable hepatocellular carcinoma after lenvatinib: Three case reports

Area of Science:

• Hepatobiliary Oncology
• Medical Oncology
• Surgical Oncology

Background:

• Lenvatinib (LEN), a multi-tyrosine kinase inhibitor, is approved for unresectable hepatocellular carcinoma (HCC).
• Its potential for tumor downstaging to facilitate conversion therapy remains under investigation.
• This case series explores LEN's role in converting unresectable HCC to a resectable or ablatable state.

Observation:

• Three patients with unresectable HCC (BCLC stage B), including one with ruptured HCC, were treated with LEN after transcatheter arterial embolization.
• Patients maintained adequate liver function (Child-Pugh 5, modified albumin-bilirubin grade 1 or 2a) during treatment.
• Tumor burden reduction and absence of satellite nodes were observed after 6 months of LEN therapy.

Findings:

• Lenvatinib treatment led to downstaging of HCC from BCLC stage B to A in all cases.
• Successful conversion therapy (hepatectomy or ablation) was achieved post-LEN treatment.
• Patients experienced good general condition with no tumor recurrence during a median 10-month follow-up.

Implications:

• Lenvatinib facilitates tumor downstaging, acting as a bridge to curative-intent therapies for unresectable HCC.
• This strategy may expand treatment options for initially unresectable HCC while preserving liver function.
• LEN shows promise in enabling conversion therapy for advanced liver cancer.