TACEと分子標的薬の併用療法の臨床成績

抄録

Primary liver cancer is the third most common cause of cancer mortality in the world. Hepatocellular carcinoma (HCC) is the dominant type of liver cancer, accounting for approximately 75% of the total. Molecular targeted agent (MTA) therapy is the guideline-recommended treatment for patients with well-preserved liver function (Child-Pugh A) and with advanced-stage (Barcelona Clinic Liver Cancer [BCLC] Stage C) HCC. There is a high level of evidence supporting transarterial chemoembolization (TACE) as the current standard of care for intermediate-stage (BCLC-B) HCC. The development of MTAs encourages us to consider a new treatment strategy for intermediate-stage HCCs. We must maximize the benefits of both treatments, TACE and MTA, for patients with intermediate and advanced HCC. Recently, some reports showed that patients with intermediate-stage HCC beyond up-to-7 criteria received initial treatment with lenvatinib (LEN) followed by TACE (LEN-TACE sequential therapy). LEN-TACE sequential therapy was shown to prolong survival compared to LEN monotherapy. We have had cases in which re-challenge TACE was effective after LEN therapy for cases refractory to initial TACE. Our re-challenge TACE cases were in the state of LEN-refractoriness/intolerance. In our clinical results, LEN with re-challenge TACE prolonged survival compared to LEN monotherapy. Re-challenge TACE showed a good overall response rate (CR+PR) at 65.2%. As adverse events of LEN, it causes tumor-related hemorrhages despite rapid suppression of tumor blood flow. In our clinical results, five of 68 consecutive cases developed tumor hemorrhages. These five cases had larger tumors than those without hemorrhages.