scholarly journals Exploratory Analysis to Identify Candidates Benefitting from Combination Therapy of Transarterial Chemoembolization and Sorafenib for First-Line Treatment of Unresectable Hepatocellular Carcinoma: A Multicenter Retrospective Observational Study

Liver Cancer ◽  
2020 ◽  
Vol 9 (3) ◽  
pp. 308-325
Author(s):  
Zhexuan Wang ◽  
Enxin Wang ◽  
Wei Bai ◽  
Dongdong Xia ◽  
Rong Ding ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Combination Therapy ◽  
Observational Study ◽  
Transarterial Chemoembolization ◽  
Exploratory Analysis ◽  
Retrospective Observational Study ◽  
Line Treatment ◽  
First Line ◽  
Unresectable Hepatocellular Carcinoma ◽  
First Line Treatment

scholarly journals Development of a Model to Predict Liver Decompensation prior to Transarterial Chemoembolization Refractoriness in Patients with Intermediate-Stage Hepatocellular Carcinoma

2021 ◽  
pp. 1-9
Author(s):  
Joel Ferreira-Silva ◽  
Pedro Costa-Moreira ◽  
Helder Cardoso ◽  
Rodrigo Liberal ◽  
Pedro Pereira ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Transarterial Chemoembolization ◽  
Objective Response ◽  
Intermediate Stage ◽  
Line Treatment ◽  
First Line ◽  
Hepatic Reserve ◽  
Liver Decompensation ◽  
Pugh Class ◽  
First Line Treatment

<b><i>Introduction:</i></b> Transarterial chemoembolization (TACE) is the first-line treatment for patients with intermediate-stage hepatocellular carcinoma (HCC). For patients without an adequate response, current finding suggests that treatment with molecular target agents, approved for advanced stage, might present benefits. However, this requires a preserved liver function. This study aims to evaluate possible predictors of early deterioration of hepatic reserve, prior to TACE refractoriness, in a cohort of patients treated with TACE. <b><i>Methods:</i></b> Retrospective analysis of 99 patients with<b><i></i></b>Child-Pugh class A and intermediate-stage HCC who underwent TACE as the first-line treatment. All patients were submitted to a biochemical and medical evaluation prior to initial TACE and every month afterward. Response to initial TACE was evaluated at 1 month. The time to Child-Pugh class deterioration before TACE refractoriness was assessed. <b><i>Results:</i></b> Ninety-nine patients were included. Objective response rate (ORR) to initial TACE was assessed as present in 59 (63.4%) and as absent in 34 (36.6%) patients. Liver decompensated before TACE refractoriness in 51 (51.5%) patients, and the median time to liver decompensation was 14 (IQR 8–20) months after first TACE. In multivariate analysis, beyond up-to-7 criteria (HR 2.4, <i>p</i> = 0.031), albumin &#x3c;35 mg/dL (HR 3.5, <i>p</i> &#x3c; 0.001) and absence of ORR (HR 2.4, <i>p</i> = 0.020) were associated with decreased overall survival free of liver decompensation. Moreover, beyond up-to-7 criteria, albumin &#x3c;35 mg/dL and absence of ORR associated negatively with 6-month survival free of liver decompensation. Our model created using those variables was able to predict liver decompensation at 6 months with an AUROC of 0.701 (<i>p</i> = 0.02). <b><i>Conclusions:</i></b> The absence of ORR after initial TACE, beyond up-to-7 criteria and albumin &#x3c;35 mg/dL, was a predictive factor for early liver decompensation before TACE refractoriness in our population. Such patients might benefit from treatment escalation to systemic therapy, in monotherapy or in combination with TACE.

scholarly journals The Cost-Effectiveness of Lenvatinib in the Treatment of Advanced or Unresectable Hepatocellular Carcinoma from a Canadian Perspective

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Brandon M. Meyers ◽  
Arndt Vogel ◽  
Paul Marotta ◽  
Petr Kavan ◽  
Laveena Kamboj ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Overall Survival ◽  
Cost Effectiveness ◽  
Phase Iii ◽  
Line Treatment ◽  
First Line ◽  
Unresectable Hepatocellular Carcinoma ◽  
Canadian Perspective ◽  
The Cost ◽  
First Line Treatment

Lenvatinib is an oral multikinase inhibitor indicated for the first-line treatment of unresectable hepatocellular carcinoma (uHCC). In the Phase III REFLECT trial, lenvatinib was noninferior in the primary endpoint of overall survival versus sorafenib, the only systemic therapy funded in Canada prior to the introduction of lenvatinib. Lenvatinib also demonstrated statistically significant improvement compared to sorafenib in secondary endpoint progression-free survival, time to progression, and objective response rate. The aim of this analysis was to estimate the cost-effectiveness of lenvatinib versus sorafenib for the first-line treatment of patients with uHCC from a Canadian perspective. A cost-utility analysis was conducted using partitioned survival modelling, with health states representing progression-free disease, progressed disease, and death. Health effects were measured using quality-adjusted life years (QALYs), and costs were represented in Canadian dollars. Clinical inputs were derived from the REFLECT trial, with outcomes extrapolated using parametric survival models. EQ-5D data collected in REFLECT were used to determine health state utility values, and estimates of resource use came from a survey of clinicians. The model predicted incremental costs of-$5,021 and incremental QALYs of 0.17, making lenvatinib dominant over sorafenib. The model demonstrates lenvatinib to be a cost-effective use of resources versus sorafenib in Canada for the treatment of uHCC. Overall costs are lower compared with sorafenib, while health benefits are greater, with modelled progression-free and overall survival extended by 4.1 and 2.6 months in the lenvatinib arm, respectively.

scholarly journals Lenvatinib versus sorafenib in first-line treatment of patients with unresectable hepatocellular carcinoma: a randomised phase 3 non-inferiority trial

The Lancet ◽  
2018 ◽  
Vol 391 (10126) ◽  
pp. 1163-1173 ◽  
Author(s):  
Masatoshi Kudo ◽  
Richard S Finn ◽  
Shukui Qin ◽  
Kwang-Hyub Han ◽  
Kenji Ikeda ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Line Treatment ◽  
First Line ◽  
Phase 3 ◽  
Unresectable Hepatocellular Carcinoma ◽  
First Line Treatment

scholarly journals Real-world effectiveness of lenvatinib monotherapy among unresectable hepatocellular carcinoma patients in the USA

2021 ◽  
Author(s):  
Amit G Singal ◽  
Saurabh P Nagar ◽  
Abby Hitchens ◽  
Keith L Davis ◽  
Shrividya Iyer
Keyword(s):  
Hepatocellular Carcinoma ◽  
Real World ◽  
Progression Free Survival ◽  
Clinical Effectiveness ◽  
Line Treatment ◽  
First Line ◽  
Unresectable Hepatocellular Carcinoma ◽  
Best Response ◽  
The Usa ◽  
First Line Treatment

Aim: This study evaluated the effectiveness of lenvatinib monotherapy for first-line treatment of unresectable hepatocellular carcinoma (uHCC) in a real-world setting. Materials & methods: This retrospective cohort study included patients who initiated lenvatinib monotherapy as first-line treatment for uHCC (n = 233). Clinical outcomes included provider-reported best response, progression-free survival (PFS) and overall survival (OS). PFS and OS were estimated using Kaplan–Meier methods. Results: Most patients (67.8%) were male. A total of 44.6% had Child-Pugh A and 39.1% had Child-Pugh B. Dose reductions were reported in 9%. Median PFS and OS were not reached. At 6 and 12 months, landmark PFS were 85.1 and 64.9%, respectively; landmark OS were 91.8 and 72.6%, respectively. Conclusion: These results affirm the clinical effectiveness of first-line lenvatinib monotherapy in uHCC.

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