Does the Addition of Hepatic Arterial Infusion Chemotherapy to Lenvatinib Improve Outcomes in aHCC?

A retrospective review offers insights into the safety and efficacy of adding hepatic arterial infusion chemotherapy using cisplatin (CDDP) to lenvatinib (lenva+CDDP) for patients with advanced hepatocellular carcinoma (aHCC).

Dr. Makoto Yamamoto and colleagues are presenting the results of this review at the 2024 American Society of Clinical Oncology Gastrointestinal Cancers Symposium.

Previous phase 2 research demonstrated the antitumor effects of lenva+CDDP in patients with aHCC and no prior history of systemic chemotherapy. However, whether the efficacy of lenva+CDDP is superior to lenvatinib alone in this population remains unclear.

Researchers reviewed the medical records of 140 patients with aHCC and a Child-Pugh score of 5, 6, or 7 who were treated with lenva+CDDP (n=40) or lenvatinib monotherapy (n=100). Patients in both groups received a once-daily dose of lenvatinib (8 mg or 12 mg according to their weight), and the lenva+CDDP group also received CDDP 65 mg/m² every 4 weeks.

Treatment was repeated until tumor progression or unacceptable toxicity, researchers noted, adding that 12 and 19 patients were previously treated with immunotherapy in the lenva+CDDP group and lenvatinib group, respectively.

The objective response and tumor control rates in the lenva+CDDP group were 67.5% and 100%, respectively, compared with 17.0% and 87.0%, respectively, in the lenvatinib group.

The median progression-free survival (PFS) and overall survival (OS) were 8.8 months and 19.6 months, respectively, in the lenva+CDDP group, compared with 5.6 months and 20.3 months, respectively, in the lenvatinib group. Among those who previously received immunotherapy, the median PFS, median OS, and 1-year survival rate were 9.7 months, not reached, and 87.5%, respectively, in the lenva+CDDP group, compared with 4.7 months, 15.8 months, and 64.7%, respectively, in the lenvatinib group.

Grade 3-4 hematological toxicities were more frequently observed in the lenva+CDDP group than in the lenvatinib group, researchers reported, though they noted that all grade 3-4 adverse events were reversible and there were no treatment-related deaths in either group.

“Lenva+CDDP demonstrated a better response and patient outcome than lenvatinib and was well tolerated in patients with advanced HCC,” Dr. Yamamoto and colleagues concluded, adding that a randomized controlled trial comparing the efficacy of these treatment approaches is underway.