A case of unresectable huge hepatocellular carcinoma achieving complete response upon treatment with lenvatinib after split drug-eluting bead transarterial chemoembolization

Abstract

An 81-year-old male with unresectable hepatocellular carcinoma (HCC) was treated with lenvatinib after split drug-eluting bead transarterial chemoembolization (DEB-TACE). He was referred to our department for the further examination of AST and ALT elevations. A 15-cm-diameter internal heterogeneous HCC occupied the left lobe of the liver. The tumor was unresectable and we initially performed split DEB-TACE to reduce the amount of tumor and to avoid adverse events including tumor lysis syndrome and postembolization syndrome. He was treated with DEB-TACE without any trouble except temporary elevations of both AST and ALT. After a series of DEB-TACE, CT images showed that residual HCC remained viable at the periphery of the tumor, and lenvatinib treatment was initiated. Three months after the initiation of lenvatinib treatment, a complete response was achieved, and serum AFP and PIVKA-2 levels declined to normal. Since then, CR has been maintained by continuing lenvatinib.