Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 26, 2020; 8(12): 2574-2584
Published online Jun 26, 2020. doi: 10.12998/wjcc.v8.i12.2574
Lenvatinib for large hepatocellular carcinomas with portal trunk invasion: Two case reports
Satoshi Komiyama, Kazushi Numata, Satoshi Moriya, Hiroyuki Fukuda, Makoto Chuma, Shin Maeda
Satoshi Komiyama, Kazushi Numata, Satoshi Moriya, Hiroyuki Fukuda, Makoto Chuma, Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Kanagawa 2320024, Japan
Shin Maeda, Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa 2360004, Japan
Author contributions: Komiyama S, Numata K, Moriya S, Fukuda H and Chuma M reviewed the literature and drafted the manuscript; Maeda S were responsible for the revision of the manuscript for important intellectual content; all authors issued final approval for the version to be submitted.
Informed consent statement: Informed written consent was obtained from the patients for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
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: Kazushi Numata, MD, PhD, Clinical Professor, Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune, Minami-ku, Yokohama, Kanagawa 2320024, Japan. kz-numa@urahp.yokohama-cu.ac.jp
Received: March 19, 2020
Peer-review started: March 19, 2020
First decision: April 7, 2020
Revised: April 24, 2020
Accepted: June 4, 2020
Article in press: June 4, 2020
Published online: June 26, 2020
Abstract
BACKGROUND

In a phase III trial of lenvatinib as first-line treatment for advanced unresectable hepatocellular carcinoma (uHCC), the drug proved non-inferior to sorafenib in terms of the overall survival, but offered better progression-free survival. However, the effects of lenvatinib in uHCC patients with a tumor thrombus in the main portal vein and/or a high tumor burden (tumor occupancy more than 50% of the total liver volume), remain unclear, because these were set as exclusion criteria in the aforementioned trial.

CASE SUMMARY

A 53-year-old man (case 1) and 66-year-old woman (case 2) with uHCC presented to us with a tumor thrombus in both the main portal vein and inferior vena cava, a high tumor burden accompanied by a tumor diameter greater than > 100 mm, and distant metastasis, with the residual liver function classified as grade 2A according to the modified Albumin–Bilirubin grading. We started both patients on lenvatinib. The therapeutic effect, as evaluated by the modified Response Evaluation Criteria in Solid Tumors, was rated as partial response in both case 1 and case 2 (at 8 wk and 4 wk after the start of lenvatinib administration, respectively). The therapeutic effect was sustained for 6 mo in case 1 and 20 mo in case 2. Fever occurred as an adverse event in both case 1 and 2, and hyperthyroidism and thrombocytopenia in only case 2, neither of which, however, necessitated treatment discontinuation.

CONCLUSION

Even in hepatocellular carcinoma patients with poor prognostic factors, if the liver function is well-preserved, lenvatinib is effective and safe.

Keywords: Hepatocellular carcinoma, Lenvatinib, Modified Response Evaluation Criteria in Solid Tumors, Main portal vein tumor thrombus, High tumor burden, Case report

Core tip: We present two cases of unresectable hepatocellular carcinoma with a tumor thrombus in the main portal vein and a high tumor burden accompanied by a tumor diameter > 100 mm. Despite the aforementioned poor prognostic factors, due to the well-preserved liver function, we elected to treat both patients with lenvatinib in the hope of obtaining tumor shrinkage, based on the REFLECT trial. Lenvatinib was demonstrated to be safe, and good therapeutic responses were obtained. Thus, even in the presence of poor prognostic factors, if the liver function is well-preserved, lenvatinib can be effective and safe in patients with unresectable hepatocellular carcinoma.