Piñero F, Thompson M, Marín JI, Silva M. Lenvatinib as first-line therapy for recurrent hepatocellular carcinoma after liver transplantation: Is the current evidence applicable to these patients? World J Transplant 2020; 10(11): 297-306 [PMID: 33312891 DOI: 10.5500/wjt.v10.i11.297]
Corresponding Author of This Article
Federico Piñero, MD, MSc, Academic Research, Doctor, Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Av. Presidente Perón 1500, Pilar, Buenos Aires B1629HJ, Argentina. fpinerof@cas.austral.edu.ar
Research Domain of This Article
Transplantation
Article-Type of This Article
Opinion Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Transplant. Nov 28, 2020; 10(11): 297-306 Published online Nov 28, 2020. doi: 10.5500/wjt.v10.i11.297
Lenvatinib as first-line therapy for recurrent hepatocellular carcinoma after liver transplantation: Is the current evidence applicable to these patients?
Federico Piñero, Marcos Thompson, Juan Ignacio Marín, Marcelo Silva
Federico Piñero, Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Buenos Aires B1629HJ, Argentina
Federico Piñero, Marcos Thompson, Marcelo Silva, Hospital Universitario Austral, Facultad de Ciencias Biomédicas, Universidad Austral, Buenos Aires B1629HJ, Argentina
Federico Piñero, Marcelo Silva, Latin American Liver Research Educational and Awareness Network (LALREAN), Buenos Aires B1629HJ, Argentina
Juan Ignacio Marín, Hepatology and Liver Transplantation Unit, Hospital Pablo Tobón Uribe, Medellín 240, Colombia
Author contributions: All authors contributed equally to this paper in conception and design of the study, literature review, drafting, critical revision and editing. All authors have approved the final version.
Conflict-of-interest statement: Piñero F has received Advisory Board and speaker honoraria and he is a consultant for RAFFO, BAYER Cono Sur and BAYER Andina; research grants from the Argentinean National Institute of Cancer (INC ID-190), Argentinean National Ministry of Science and Technology Development (PICT 2017, FONCYT) and from the Latin American Liver Research Educational and Awareness Network (LALREAN). Marin J has received Advisory Board and speaker honoraria from BAYER and GILEAD. Silva M has received speaker honoraria and is a consultant for Abvie, Gador, Bristol-Myers Squibb, Merck, BAYER and has received research grants from the Argentinean National Institute of Cancer (INC ID-190), and the Argentinean National Ministry of Science and Technology Development (PICT 2017, FONCYT).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Federico Piñero, MD, MSc, Academic Research, Doctor, Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Av. Presidente Perón 1500, Pilar, Buenos Aires B1629HJ, Argentina. fpinerof@cas.austral.edu.ar
Received: May 18, 2020 Peer-review started: May 18, 2020 First decision: June 3, 2020 Revised: June 9, 2020 Accepted: September 22, 2020 Article in press: September 22, 2020 Published online: November 28, 2020 Processing time: 188 Days and 17.1 Hours
Abstract
Liver transplantation (LT) is one of the leading curative therapies for hepatocellular carcinoma (HCC). Despite recent optimization of transplant selection criteria, including alpha-feto protein, HCC recurrence after LT is still the leading cause of death in these patients. During the last decades, effective systemic treatments for HCC, including tyrosine kinase inhibitors and immunotherapy, have been approved. We describe the clinical scenario of a patient with recurrence of HCC five years after LT, who received lenvatinib as first-line systemic therapy to introduce systemic treatment options in this clinical setting. In this opinion review, we detail first and second-line systemic treatment options, focusing on those feasible for patients with recurrent HCC after LT. Several trials have evaluated new drugs to treat HCC patients in first and second-line therapy, but patients with recurrent HCC after LT have been excluded from these trials. Consequently, most of the evidence comes from observational retrospective studies. Whether tyrosine kinase inhibitors will remain the primary therapeutic approach in these patients, due to a relative contraindication for immunotherapy, may be clarified in the near future.
Core Tip: Post-transplant hepatocellular carcinoma (HCC) recurrence is a significant negative predictor of survival. There is no consensus on the treatment of recurrence. If possible, resection should be attempted. The use of systemic chemotherapy after transplant is limited to small retrospective cohort studies. Immunotherapy with checkpoint inhibitors in the post-transplant setting is challenging due to the potentially increased risk of allograft rejection. This opinion review illustrates a late post-transplant HCC recurrence treated with lenvatinib, with good tolerance and overall survival after lung and adrenal metastasis resections in a patient previously intolerant to sorafenib.
