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Anti-Angiogenic Agents for Advanced Hepatocellular Carcinoma Induce Liver Atrophy
Taijiro Wake1, Tomoharu Yamada1, Ryosuke Tateishi1
1Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Aim:
Systemic therapy for advanced hepatocellular carcinoma (HCC) includes multi-kinase inhibitors with anti-vascular endothelial growth factor (VEGF) activity and anti-VEGF monoclonal antibodies in combination with immune checkpoint inhibitors. This study aimed to investigate and compare the chronological changes in liver volume between patients who received atezolizumab plus bevacizumab (Atezo/Bev) and those who received lenvatinib.
Methods:
We enrolled patients who received initial treatment with either Atezo/Bev or lenvatinib for advanced HCC between October 2018 and May 2023. Patients underwent periodic computed tomography (CT) or magnetic resonance imaging (MRI) to evaluate systemic therapy effects. Patients with portal vein thrombosis or prior liver resection/transplantation were excluded. Liver volume was measured at baseline and at 8 and 16 weeks after the initiation of treatment using commercially available software. Liver volume at each time point was expressed as a proportion relative to baseline. A linear regression analysis was used to analyze the chronological changes in liver volume.
Results:
Seventy-three patients (40 in the Atezo/Bev group and 33 in the lenvatinib group) were included in this retrospective study. Liver volume decreased in 54 patients (74%) at week 8; the average volume relative to baseline was 0.92 (95% confidence interval: 0.90-0.94, p < 0.01). Liver volume decreased in patients with both shrinking and enlarged tumors. Multivariate analysis indicates that the decrease in nontumoral liver volume was more significant in the lenvatinib group than in the Atezo/Bev group (p = 0.04).
Conclusions:
Anti-angiogenic therapy for advanced HCC can lead to liver atrophy.
Insights
Systemic therapies for advanced hepatocellular carcinoma (HCC) can cause liver atrophy. Lenvatinib showed a more significant decrease in non-tumoral liver volume compared to atezolizumab plus bevacizumab.
Area of Science:
- Hepatology
- Medical Oncology
- Radiology
Background:
- Advanced hepatocellular carcinoma (HCC) treatment involves multi-kinase inhibitors and anti-VEGF therapies.
- Atezolizumab plus bevacizumab (Atezo/Bev) and lenvatinib are key systemic treatments for advanced HCC.
Purpose of the Study:
- To compare chronological changes in liver volume between patients treated with Atezo/Bev and lenvatinib for advanced HCC.
- To investigate the impact of anti-angiogenic therapies on liver volume in HCC patients.
Main Methods:
- Retrospective study of 73 advanced HCC patients treated with Atezo/Bev or lenvatinib.
- Liver volume measured via CT/MRI at baseline, 8, and 16 weeks.
- Linear regression analysis to assess chronological liver volume changes.
Main Results:
- A significant decrease in liver volume was observed in 74% of patients by week 8 (average relative volume 0.92).
- Liver volume decreased irrespective of tumor size changes.
- Nontumoral liver volume reduction was significantly greater in the lenvatinib group compared to the Atezo/Bev group (p=0.04).
Conclusions:
- Anti-angiogenic therapy for advanced HCC can induce liver atrophy.
- Lenvatinib may lead to more pronounced liver volume reduction than Atezo/Bev.
