Efficacy and safety of transarterial chemoembolization-lenvatinib sequential therapy for the treatment of hepatocellular carcinoma with portal vein tumor thrombus: a retrospective study

Background: The efficacy of transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT) is limited. There are insufficient data on TACE-lenvatinib sequential therapy for HCC with PVTT. We aimed to assess the efficacy and safety of TACE-lenvatinib sequential therapy for the treatment of HCC and PVTT. Methods: We retrospectively reviewed 12 consecutive patients with HCC and PVTT who underwent TACE-lenvatinib sequential therapy between July 2018 and May 2021. Lenvatinib treatment was started 1 week after TACE at a dose of 8 or 12 mg daily depending on the patient weight. Follow-up examinations were performed at 4 week and then every 8 weeks after the first TACE procedure. Overall survival (OS), progression-free survival (PFS), objective response rate (ORR), disease control rate (DCR) and adverse events (AEs) were calculated. Survival curves of PFS and OS were estimated using the Kaplan-Meier method. Results: The median OS and PFS were 16.9 and 6.15 months, respectively. The ORR and DCR were 75% and 91.7%, respectively. The most common lenvatinib-related AE was hypertension (33.3%), and the most common TACE-related AE was elevated liver enzymes (100%). No treatment-related deaths or grade 4 events were observed. Conclusions: TACE-lenvatinib sequential therapy may be safe and well tolerated, and may improve OS and PFS for HCC patients with PVTT. Further randomized controlled trials with larger cohorts are needed to confirm its efficacy and safety.