A case of advanced HCC treated with lenvatinib after hepatic arterial infusion chemotherapy combined with radiation ther
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CASE REPORT
A case of advanced HCC treated with lenvatinib after hepatic arterial infusion chemotherapy combined with radiation therapy treatment for portal vein tumor thrombosis in the main trunk Yumi Kosaka1 · Tomokazu Kawaoka1 · Hiroshi Aikata1 · Yosuke Suehiro1 · Kenji Yamaoka1 · Yuwa Ando1 · Maiko Namba1 · Yasue Takeuchi1 · Yasutomo Fujii1 · Shinsuke Uchikawa1 · Kenichiro Kodama1 · Kazuki Oya1 · Kei Morio1 · Hatsue Fujino1 · Takashi Nakahara1 · Eisuke Murakami1 · Masami Yamauchi1 · Masataka Tsuge1 · Akira Hiramatsu1 · Michio Imamura1 · Yasutaka Baba2 · Kazuo Awai2 · Tomoki Kimura3 · Yasushi Nagata3 · Kazuaki Chayama1 Received: 14 August 2019 / Accepted: 14 January 2020 © Japanese Society of Gastroenterology 2020
Abstract We report a 46-year-old male patient with functional liver damage due to hepatitis B virus infection. A 12 cm hepatocellular carcinoma (HCC) in the left lobe and portal venous tumor thrombosis (PVTT) with vp4 (portal vein tumor thrombosis in the main trunk) were detected by computed tomography (CT). He underwent hepatic arterial infusion chemotherapy (HAIC) with cisplatin 100 mg for HCC and received radiation therapy (39 Gy/13 Fr) for PVTT with vp4. Follow-up CT showed reduction of HCC and reduced PVTT volume after 1 month of treatment. He then initiated lenvatinib therapy at 12 mg/day. One month later, follow-up CT showed no change in HCC size and a reduction in PVTT volume. Two months after initiating lenvatinib, follow-up CT showed no change in HCC, but further reduction in contrast effect and volume of PVTT. Three months after HAIC, he underwent drug-eluting-bead transcatheter arterial chemoembolization (DEB-TACE) with 100 mg of cisplatin (CDDP) for the HCC. After DEB-TACE, he received 12 mg/day with 5-days-on/2-days-off due to vomiting. One month after DEB-TACE, blood evaluation showed decreased tumor markers, and CT revealed that the HCC had grown slightly with no change in PVTT. Five months after HAIC, he underwent DEB-TACE with 100 mg of cisplatin for the HCC. A total of 150 days have passed since the start of lenvatinib treatment, and his Child–Pugh A status has been maintained. Keywords Hepatocellular carcinoma · Lenvatinib · Portal venous tumor thrombosis · Hepatic arterial infusion chemotherapy · Radiation therapy
Introduction Lenvatinib is an oral multikinase inhibitor that targets the vascular endothelial cell growth factor receptors 1–3, fibroblast growth factor receptors 1–4, platelet-derived growth * Hiroshi Aikata aikata@hiroshima‑u.ac.jp 1
Department of Gastroenterology and Metabolism, Hiroshima University Hospital, 1‑2‑3 Kasumi, Minamiku, Hiroshima 734‑8551, Japan
2
Diagnostic Radiology, Hiroshima University Hospital, Hiroshima, Japan
3
Therapeutic Radiology, Institute and Graduate School of Biomedical Science, Hiroshima University Hospital, Hiroshima, Japan
factor receptor α, RET, and KIT [1–4]. In 2018, lenvatinib was reported to be non-inferior to sorafenib in patients with hepatocellular carcinoma (HCC) in a randomized phase 3 non-inferiority trial
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