Downstaging of Recurrent Advanced Hepatocellular Carcinoma After Lenvatinib Treatment: Opportunities or Pitfalls? A Case Report
Zhaobo Liu 1 , Zhi Fu 1 , Guangming Li 1 , Dongdong Lin 1
Affiliations
Affiliation
1
Department of General Surgery, Beijing Youan Hospital, Capital Medical University, Beijing 100069, People's Republic of China.
Background: The majority of patients with hepatocellular carcinoma (HCC) are diagnosed at an advanced stage that excludes them from potentially curative surgical treatment. Lenvatinib is associated with a high objective response rate (ORR) (40.6%) in advanced HCC, indicating the potential for tumor downstaging and conversion to surgical intervention. We report the case of a patient with recurrent, advanced HCC who achieved a partial response and downstaging following third-line treatment with lenvatinib but missed the opportunity for conversion hepatectomy.
Case presentation: A male Chinese patient aged 42 years presented with an obstructive liver lesion, revealed by CT imaging to be a single tumor in segments V and VIII of the liver, without macrovascular invasion. The patient had chronic hepatitis B infection, Barcelona Clinic Liver Cancer (BCLC) Stage A, normal liver function (Child-Pugh Score 5 and Grade A) and AFP level 4.45 ng/mL. The patient underwent a successful hepatectomy but experienced recurrence 14 months later. The recurrent tumor was detected at an early stage and the patient underwent successful radiofrequency ablation and transarterial chemoembolization. After a further 11 months, the patient experienced a second relapse characterized by multiple disseminated metastases in the left and right lobes of the liver and possible macrovascular invasion, equal to BCLC Stage B/C. The patient received lenvatinib and achieved a partial response with complete disappearance of a number of lesions, recovering to BCLC Stage A and becoming eligible for liver transplantation. However, the patient refused surgery and after 4 months experienced progressive disease.
Conclusion: Our case suggests that radical treatment, such as conversion hepatectomy or liver transplantation, should be undertaken quickly following downstaging and within the expected PFS time associated with lenvatinib. However, further studies are required to provide additional evidence for this treatment strategy.
病例介绍：一名中国男性患者，年龄42岁，肝脏梗阻性病变，CT显像为肝脏V段和VIII段的单个肿瘤，无大血管侵犯。该患者患有慢性乙型肝炎感染，巴塞罗那临床肝癌（BCLC）A期，肝功能正常（Child-Pugh评分5和A级）和AFP水平为4.45 ng / mL。患者成功进行了肝切除术，但在14个月后复发。早期发现复发性肿瘤，患者成功进行了射频消融和经动脉化学栓塞治疗。再过11个月后，患者经历了第二次复发，其特征是肝左叶和右叶有多个弥漫性转移灶，并可能发生大血管浸润，相当于BCLC B / C期。该患者接受了lenvatinib并获得了部分缓解，许多病变完全消失，恢复到BCLC A期并有资格进行肝移植。但是，患者拒绝手术，并且在4个月后经历了疾病进展。