Additional Treatment Using Transcatheter Arterial Infusion with Drug-Eluting Beads Transarterial Chemoembolization Contributes to Prolonged Survival of Patients with BCLC Stage C Hepatocellular Carcinoma after Discontinuing Lenvatinib: Preliminary Study

Objective: Lenvatinib is considered the first-line treatment for unresectable advanced hepatocellular\r\ncarcinoma (HCC); however, in some clinical cases, discontinuation of lenvatinib is unavoidable. It is\r\nimportant to elucidate if transcatheter arterial infusion (TAI) with drug-eluting beads transarterial\r\nchemoembolization (DEB-TACE) is a feasible second-line treatment after discontinuing lenvatinib. In this\r\nstudy, we aimed to evaluate the efficacy, hepatic function and nutritional status associated with TAI with\r\nDEB-TACE for patients who previously discontinued lenvatinib.\r\nMaterials and Methods: We included 35 patients who were prescribed lenvatinib for unresectable HCC\r\nbetween July 2018 and December 2019, of whom 12 discontinued lenvatinib during the study. The changes\r\nin the albumin-bilirubin (ALBI) score and the controlling nutritional status (CONUT) score before and after\r\ndiscontinuing lenvatinib were examined. Furthermore, the tolerability and survival of patients treated using\r\nTAI with DEB-TACE as a second-line treatment were analysed.\r\nResults: The ALBI and CONUT scores were significantly worse when lenvatinib was started and stopped\r\n(p\u003c0.05). The CONUT score was significantly worse in the second-line group than in the follow-up group\r\nwhen beginning and discontinuing lenvatinib; however, this score tended to improve after DEB-TACE. The\r\ngroup that underwent TAI with DEB-TACE as a second-line treatment had significantly better survival than\r\nthe follow-up group (log?rank test, p=0.029; generalized Wilcoxon test, p=0.042).\r\nConclusion: In patients who could undergo TAI with DEB-TACE as a second-line treatment after\r\ndiscontinuing lenvatinib, the CONUT score improved, while the ALBI score was maintained and welltolerated; these scores may have contributed to improved survival compared with follow-up patients. Future\r\nstudies with larger sample sizes are necessary to confirm our findings.