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 carcinoma (HCC); however, in some clinical cases, discontinuation of lenvatinib is unavoidable. It is important to elucidate if transcatheter arterial infusion (TAI) with drug-eluting beads transarterial chemoembolization (DEB-TACE) is a feasible second-line treatment after discontinuing lenvatinib. In this study, we aimed to evaluate the efficacy, hepatic function and nutritional status associated with TAI with DEB-TACE for patients who previously discontinued lenvatinib. Materials and Methods: We included 35 patients who were prescribed lenvatinib for unresectable HCC between July 2018 and December 2019, of whom 12 discontinued lenvatinib during the study. The changes in the albumin-bilirubin (ALBI) score and the controlling nutritional status (CONUT) score before and after discontinuing lenvatinib were examined. Furthermore, the tolerability and survival of patients treated using TAI with DEB-TACE as a second-line treatment were analysed. Results: The ALBI and CONUT scores were significantly worse when lenvatinib was started and stopped (p<0.05). The CONUT score was significantly worse in the second-line group than in the follow-up group when beginning and discontinuing lenvatinib; however, this score tended to improve after DEB-TACE. The group that underwent TAI with DEB-TACE as a second-line treatment had significantly better survival than the follow-up group (log‑rank test, p=0.029; generalized Wilcoxon test, p=0.042). Conclusion: In patients who could undergo TAI with DEB-TACE as a second-line treatment after discontinuing 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 studies with larger sample sizes are necessary to confirm our findings.