Poor Tolerability of Lenvatinib in Elderly Patients with Advanced Hepatocellular Carcinoma after Disease Progression following First-Line Atezolizumab Plus Bevacizumab: A Multicenter Study

Daisuke Kato; Takanori Suzuki; Kentaro Matsuura; Kohei Okayama; Fumihiro Okumura; Yoshihito Nagura; Satoshi Sobue; Katsumi Hayashi; Atsunori Kusakabe; Izumi Hasegawa; Sho Matoya; Tsutomu Mizoshita; Yoshihide Kimura; Hiromu Kondo; Atsushi Ozasa; Hayato Kawamura; Kei Fujiwara; Shunsuke Nojiri; Hiromi Kataoka; Sakurayama Liver Study Group (SLSG)

doi:10.1159/000541455

Poor Tolerability of Lenvatinib in Elderly Patients with Advanced Hepatocellular Carcinoma after Disease Progression following First-Line Atezolizumab Plus Bevacizumab: A Multicenter Study

Oncology. 2024 Oct 18:1-9. doi: 10.1159/000541455. Online ahead of print.

Authors

Daisuke Kato¹, Takanori Suzuki², Kentaro Matsuura², Kohei Okayama³, Fumihiro Okumura³, Yoshihito Nagura⁴, Satoshi Sobue⁴, Katsumi Hayashi¹, Atsunori Kusakabe⁵, Izumi Hasegawa⁵, Sho Matoya⁶, Tsutomu Mizoshita⁶, Yoshihide Kimura⁷, Hiromu Kondo⁸, Atsushi Ozasa⁹, Hayato Kawamura², Kei Fujiwara², Shunsuke Nojiri², Hiromi Kataoka²; Sakurayama Liver Study Group (SLSG)

Affiliations

¹ Department of Gastroenterology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan.
² Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
³ Department of Gastroenterology, Gifu Prefectural Tajimi Hospital, Tajimi, Japan.
⁴ Department of Gastroenterology, Kasugai Municipal Hospital, Kasugai, Japan.
⁵ Department of Gastroenterology, Chukyo Hospital, Nagoya, Japan.
⁶ Department of Gastroenterology, Toyokawa City Hospital, Toyokawa, Japan.
⁷ Department of Gastroenterology, Nagoya City University West Medical Center, Nagoya, Japan.
⁸ Department of Gastroenterology, Nagoya City East Medical Center, Nagoya, Japan.
⁹ Department of Gastroenterology, Asahi Rousai Hospital, Owariasahi, Japan.

PMID: 39427645
DOI: 10.1159/000541455

Abstract

Introduction: We investigated the effectiveness of lenvatinib (LEN) after disease progression following first-line treatment with atezolizumab plus bevacizumab (Atez/Bev) in patients with unresectable hepatocellular carcinoma (HCC).

Methods: One hundred and ten HCC patients treated with Atez/Bev as first-line systemic chemotherapy were enrolled and underwent dynamic computerized tomography/magnetic resonance imaging to determine the treatment response. We evaluated the treatment efficacy and prognosis after second-line LEN treatment, especially in elderly patients.

Results: Of the 110 study patients, 88 patients (80%) were determined to have progressive disease (PD) during the observation periods, and 40 patients received second-line LEN therapy. The 40 patients included 13 patients who were unable to continue LEN until the initial evaluation due to adverse events (AE). The 27 patients who were able to continue LEN therapy (Group A) were significantly younger at initiation of Atez/Bev than those who could not continue (71 vs. 77 years old, p = 0.013). Comparing the OS and PFS between Group A and 44 patients that included 13 patients who were unable to continue LEN and 31 patients did not receive the second-line treatment (Group B), the former had significantly better OS than Group B (31.1 vs. 17.8 months, p = 0.035).

Conclusions: The tolerability of second-line LEN therapy was lower in elderly patients, and the OS from the start of Atez/Bev therapy was different depending on the tolerability of second-line LEN therapy.

Keywords: Elderly; Hepatocellular carcinoma; Lenvatinib.