Efficacy and safety of lenvatinib for preventing tumor recurrence after liver transplantation in hepatocellular carcinoma beyond the Milan criteria

De-Zhen Guo; Jian-Wen Cheng; Jia-Yan Yan; Ao Huang; Yu-Peng Wang; Shi-Yu Zhang; Ya Cao; Xiao-Wu Huang; Jia Fan; Jian Zhou; Xin-Rong Yang

doi:10.21037/atm-22-1353

Efficacy and safety of lenvatinib for preventing tumor recurrence after liver transplantation in hepatocellular carcinoma beyond the Milan criteria

Ann Transl Med. 2022 Oct;10(20):1091. doi: 10.21037/atm-22-1353.

Authors

De-Zhen Guo^#^{1

2}, Jian-Wen Cheng^#^{1

2}, Jia-Yan Yan^{1

2}, Ao Huang^{1

2}, Yu-Peng Wang^{1

2}, Shi-Yu Zhang^{1

2}, Ya Cao³, Xiao-Wu Huang^{1

2}, Jia Fan^{1

2

4}, Jian Zhou^{1

2

4

5}, Xin-Rong Yang^{1

2}

Affiliations

¹ Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University; Key Laboratory of Carcinogenesis and Cancer Invasion (Fudan University), Ministry of Education, Shanghai, China.
² Shanghai Key Laboratory of Organ Transplantation, Zhongshan Hospital, Fudan University, Shanghai, China.
³ Cancer Research Institute, Central South University; Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Changsha, China.
⁴ Institute of Biomedical Sciences, Fudan University, Shanghai, China.
⁵ State Key Laboratory of Genetic Engineering, Fudan University, Shanghai, China.

^# Contributed equally.

Abstract

Background: Lenvatinib is one of the first-line treatments for unresectable hepatocellular carcinoma (HCC). However, data are lacking on lenvatinib in the postoperative setting.

Methods: This retrospective analysis enrolled 242 patients with HCC who underwent liver transplantation (LTx). Eligible patients were divided into 2 groups according to their use of adjuvant lenvatinib following LTx (lenvatinib, n=42; control, n=200). The primary outcome measures were overall survival (OS), time to recurrence (TTR), and safety. Kaplan-Meier analysis was applied to calculate the OS, while a competing risk model was used to estimate the cumulative incidence of recurrence.

Results: The lenvatinib group showed more advanced tumors and a higher proportion of HCC beyond the Milan criteria (P<0.001) than the control group. There were no significant differences in both the OS and TTR between the 2 groups. After focusing on the patients with HCC beyond the Milan criteria, baseline characteristics were similar in the lenvatinib group (n=38) and the control group (n=102). Competing risk analysis showed lenvatinib significantly prolonged TTR after LTx versus the control group [sub-hazard ratio (sHR), 0.40; 95% confidence interval (CI): 0.17 to 0.93; P=0.031]. In the multivariate competing risk model, adjuvant lenvatinib was an independent protective factor for tumor recurrence after LTx in patients with HCC beyond the Milan criteria (sHR, 0.33; 95% CI: 0.13 to 0.83; P=0.018). The rate of early recurrence within t2 years after LTx was also significantly decreased in the lenvatinib group (15.8% vs. 33.3%, P=0.041). However, the lenvatinib group exhibited comparable OS with the control group in patients with HCC beyond the Milan criteria. Treatment-related adverse events (TRAEs) and Grade ≥3 TRAEs occurred in 40 (95.2%) and 13 (31%) patients who received adjuvant lenvatinib, respectively. No treatment-related death was reported.

Conclusions: Postoperative lenvatinib administration may provide clinical benefits and is well tolerated in patients with HCC beyond the Milan criteria who undergo LTx.

Keywords: Lenvatinib; competing risk model; hepatocellular carcinoma (HCC); liver transplantation (LTx); recurrence.