背景:伦伐替尼(LEN)是一种新型有效的多酪氨酸激酶抑制剂,被批准为不可切除的肝细胞癌(HCC)的一线治疗。考虑到其客观响应率高,LEN治疗有望实现肿瘤的降级,并导致肝切除术或消融的转化治疗。然而,在无法切除的HCC中,LEN治疗后转换治疗的可行性仍然未知.
■这里,我们报告了3例无法切除的HCC:病例1,一名69岁男性诊断为破裂型HCC;病例2,一名72岁女性非酒精性脂肪性肝炎型HCC;病例3,一名73岁男性有酒精性肝硬化型HCC病史.
方法:在所有情况下,肝硬化分为Child-Pugh5级和改良白蛋白-胆红素1级或2a级。HCC被诊断为巴塞罗那临床肝癌(BCLC)B期。
方法:在所有情况下,LEN在常规经导管动脉栓塞实施后开始,同时保持肝功能。
结果:在所有情况下,LEN治疗6个月后,主要肿瘤大小减小,未检测到卫星淋巴结,表明HCC的分期降至BCLCA期。随后,进行了转换性肝切除术或消融术.转换治疗成功后,患者的一般情况良好,观察期间无肿瘤复发(中位数10个月)。
结论:这项研究表明,LEN可以降低HCC的分期,因此代表了成功手术或消融治疗的桥梁。特别是,LEN治疗可能有助于最初不可切除的HCC的转化治疗的可能性,同时保持肝功能储备。
BACKGROUND: Lenvatinib (LEN) is a novel potent multi-tyrosine kinase inhibitor, approved as first-line treatment for unresectable hepatocellular carcinoma (HCC). Considering its high objective response rate, LEN therapy could be expected to achieve downstaging of tumors and lead to conversion therapy with hepatectomy or ablation. However, the feasibility of conversion therapy after LEN treatment in unresectable HCC remains largely unknown.
UNASSIGNED: Here, we reported 3 cases of unresectable HCC:
case 1, a 69-year-old man diagnosed with ruptured HCC;
case 2, a 72-year-old woman with nonalcoholic steatohepatitis-based HCC; and
case 3, a 73-year-old man with a history of alcoholic cirrhosis-based HCC.
METHODS: In all cases, cirrhosis was classified as Child-Pugh 5 and modified albumin-bilirubin grade 1 or 2a. HCC was diagnosed as Barcelona Clinic Liver Cancer (BCLC) stage B.
METHODS: In all cases, LEN was initiated after conventional-transcatheter arterial embolization enforcement, while maintaining liver function.
RESULTS: In all cases, the main tumor size decreased after 6 months of LEN treatment and no satellite nodes were detected, indicating downstaging of HCC to BCLC stage A. Subsequently, conversion hepatectomy or ablation was performed. After successful conversion therapy, the general condition of the patients was good, without tumor recurrence during the observation period (median 10 months).
CONCLUSIONS: This study demonstrated that LEN enables downstaging of HCC and thus represents a bridge to successful surgery or ablation therapy. In particular, LEN treatment may facilitate the possibility for conversion therapy of initially unresectable HCC, while maintaining the hepatic functional reserve.