Hepatocellular Carcinoma Showing Pathological Complete Response to Lenvatinib Monotherapy

A 61-year-old man was referred to our hospital due to the liver dysfunction without hepatitis B or C infection. In addition to the elevated levels of α-fetoprotein (AFP) and protein induced by vitamin K absence or antagonist-II, a large tumor, 10.8 cm in size, and multiple small tumors, up to 1.6 cm in size, in the liver on computed tomography (CT) led to the diagnosis of unresectable advanced hepatocellular carcinoma (HCC). Levatinib monotherapy resulted in complete disappearance of the small liver tumors and marked shrinkage of the largest tumor with complete disappearance of intratumoral enhancement on CT and normalization of serum AFP levels. After 2 months' cessation of lenvatinib monotherapy due to side effects, the patient underwent residual tumor resection. The pathological findings showed no viable tumor cells, i.e. pathological complete response. The patient was discharged from the hospital on the twelfth day after the operation without any complication. Lenvatinib monotherapy appears to be more effective for HCC than other conventional treatments. In addition, oncologists should take into consideration the possibility of pathological complete response with newly developed anticancer agents including lenvatinib to develop therapeutic strategies to avoid unnecessary overtreatment.