Surgical intervention after lenvatinib treatment in patients with advanced hepatocellular carcinoma

Abstract Background Survival efficacy and prognostic factors in patients with advanced hepatocellular carcinoma (HCC) who underwent surgical intervention after lenvatinib treatment is not well-understood.Methods Patients with advanced HCC who had lenvatinib treatment were retrospectively analyzed.Results Of 70 patients who were treated with lenvatinib, 14 patients underwent surgical intervention after lenvatinib treatment for 4–28 weeks. PFS was significantly longer in patients with surgical intervention than in patients with non-surgical treatment (median, 8.6 vs. 5.1 months, p = 0.019). Non-significant longer OS was also observed in patients with surgical intervention compared to patients with non-surgical treatment (median, unreached vs. 21.0 months, p = 0.206). In patients who underwent surgical intervention, 2 patients had a PR, and 12 had SD according to RECIST ver. 1.1 criteria. The serum AFP level was significantly lower after lenvatinib treatment than before lenvatinib treatment (median, 19.2 vs. 196.5 ng/mL, p = 0.0081). Eleven patients underwent curative surgery with a 14% major postoperative complication (Clavien‒Dindo ≥ IIIa) rate. Patients who exhibited decreases in AFP levels or were within the normal range of AFP levels during lenvatinib treatment had significantly longer PFS (median, 8.6 vs. 3.0 months, p = 0.0009) and OS (median, unreached vs. 12.4 months, p = 0.012) than patients who had AFP levels beyond the normal range that did not decrease during lenvatinib treatment.Conclusions Surgical intervention after lenvatinib treatment for advanced HCC was associated with longer PFS. Patients exhibiting decreases in AFP levels or were within the normal limit of AFP levels may be good candidates for surgical intervention after lenvatinib treatment for advanced HCC.