Effectiveness of Combination Therapy of Stereotactic Body Radiation Therapy with Lenvatinib in Advanced Hepatocellular Carcinoma

Alifia Sabira Putri(1), Rovera Nuriasti(2), Balqis Prudena Kurnia Pambudi(3), Naufal Revaldy Fauzan(4), Baiq Zaskia Maudina(5), Yoga Prawira(6), Anak Agung Ayu Regina Larasati(7), Catarina Budyono(8),


(1) Faculty of Medicine and Health Science, University of Mataram, Mataram, Indonesia
(2) Faculty of Medicine and Health Science, University of Mataram, Mataram, Indonesia
(3) Faculty of Medicine and Health Science, University of Mataram, Mataram, Indonesia
(4) Faculty of Medicine and Health Science, University of Mataram, Mataram, Indonesia
(5) Faculty of Medicine and Health Science, University of Mataram, Mataram, Indonesia
(6) Faculty of Medicine and Health Science, University of Mataram, Mataram, Indonesia
(7) Faculty of Medicine and Health Science, University of Mataram, Mataram, Indonesia
(8) Faculty of Medicine and Health Science, University of Mataram, Mataram, Indonesia
Corresponding Author

Abstract


Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer and has a high mortality rate, especially in advanced stages. Treatment of advanced HCC remains a significant challenge due to limited effective therapeutic options. This study examines the effectiveness of combining Stereotactic Body Radiation Therapy (SBRT) and Lenvatinib in advanced HCC patients. SBRT is a high-precision radiation technique that allows high-dose irradiation of tumor targets with minimal damage to surrounding healthy tissues. At the same time, Lenvatinib is a multikinase inhibitor that inhibits several critical molecular pathways in angiogenesis and tumor cell proliferation. The results showed that the combination of SBRT and Lenvatinib significantly improved overall survival (OS) by reducing the risk of death by 63%, progression-free survival (PFS) reduced the risk of tumor progression by 67%, intrahepatic tumor progression-free survival (IHPFS) showed a decrease of 71%, objective remission rate (ORR) was also higher in the combination group (56.8%), and disease control rate (DCR) of 91.9% which was higher than the use of Lenvatinib alone. However, this combination therapy also carries a higher risk of side effects, including hypertension and diarrhea, which require close monitoring and dose adjustment. This study suggests combining SBRT and Lenvatinib may be a more practical approach to treating advanced HCC. However, the treatment strategy needs to be tailored to the patient's condition to minimize the risk of toxicity.


Keywords


Hepatocellular carcinoma (HCC), lenvatinib, Stereotactic Body Radiation Therapy (SBRT), terapi kombinasi

References


McGlynn KA, Petrick JL, El‐Serag HB. Epidemiology of hepatocellular carcinoma. Hepatology. 2021;73(S1):4-13. doi:10.1002/hep.31288.

Llovet JM, Montal R, Sia D, Finn RS. Molecular therapies and precision medicine for hepatocellular carcinoma. Nat Rev Clin Oncol. 2018;15(10):599-616. doi:10.1038/s41571-018-0073-4.

Kouroumalis E, Tsomidis I, Voumvouraki A. Pathogenesis of hepatocellular carcinoma: The interplay of apoptosis and autophagy. Biomedicines. 2023;11(4):1-45. doi:10.3390/biomedicines11041166.

Argentiero A, Delvecchio A, Fasano R, et al. The complexity of the tumor microenvironment in hepatocellular carcinoma and emerging therapeutic developments. J Clin Med. 2023;12(23):1-10. doi:10.3390/jcm12237469.

Hu Y, Zhao C, Ji R, et al. The role of stereotactic body radiotherapy in hepatocellular carcinoma: Guidelines and evidences. J Natl Cancer Cent. 2022;2(3):171-182. doi:10.1016/j.jncc.2022.05.002.

Macià I Garau M. Radiobiology of stereotactic body radiation therapy (SBRT). Rep Pract Oncol Radiother. 2017;22(2):86-95. doi:10.1016/j.rpor.2017.02.010.

Koka K, Verma A, Dwarakanath BS, Papineni RV. Technological advancements in external beam radiation therapy (EBRT): An indispensable tool for cancer treatment. Cancer Manag Res. 2022;14:1421-1429. doi:10.2147/CMAR.S351744.

Miften M, Vinogradskiy Y, Moiseenko V, et al. Radiation dose‐volume effects for liver SBRT. Int J Radiat Oncol Biol Phys. 2021;110(1):196-205. doi:10.1016/j.ijrobp.2017.12.290.

Saini G. Stereotactic body radiation therapy in hepatocellular carcinoma. Indian J Med Paediatr Oncol. 2020;41(4):488-491. doi:10.4103/ijmpo.ijmpo_67_20.

Rim CH, Kim HJ, Seong J. Clinical feasibility and efficacy of stereotactic body radiotherapy for hepatocellular carcinoma: A systematic review and meta-analysis of observational studies. Radiother Oncol. 2019;131:135-144. doi:10.1016/j.radonc.2018.12.005.

Cabanillas ME, Habra MA. Lenvatinib: Role in thyroid cancer and other solid tumors. Cancer Treat Rev. 2016;42:47-55. doi:10.1016/j.ctrv.2015.11.003.

Tan DJH, Wong C, Ng CH, et al. A meta-analysis on the rate of hepatocellular carcinoma recurrence after liver transplant and associations to etiology, alpha-fetoprotein, income and ethnicity. J Clin Med. 2021;10(2):1-14. doi:10.3390/jcm10020238.

Ji X, Xu Z, Sun J, et al. Lenvatinib with or without stereotactic body radiotherapy for hepatocellular carcinoma with portal vein tumor thrombosis: A retrospective study. Radiat Oncol. 2023;18(1):1-12. doi:10.1186/s13014-023-02270-z.

Tsoris A, Marlar C. Use of the Child-Pugh score in liver disease. StatPearls. March 2023. Accessed September 16, 2024. Available from: https://www.ncbi.nlm.nih.gov/books/NBK542308/.

Aly A, Fulcher N, Seal B, et al. Clinical outcomes by Child-Pugh class in patients with advanced hepatocellular carcinoma in a community oncology setting. Hepat Oncol. 2023;10(1). doi:10.2217/hep-2023-0002.

Reig M, Forner A, Rimola J, et al. BCLC strategy for prognosis prediction and treatment recommendation: The 2022 update. J Hepatol. 2022;76(3):681-693. doi:10.1016/j.jhep.2021.11.018.

Hasan I, Loho IM, Lesmana CRA, et al. Treatment for intermediate-stage hepatocellular carcinoma: Current practice and outcome in real world study. Indones J Gastroenterol Hepatol Dig Endosc. 2022;23(1):24-28. doi:10.24871/231202224-28.


Full Text: PDF

Article Metrics

Abstract View : 403 times
PDF Download : 241 times

DOI: 10.24871/2622025168-175

Refbacks

  • There are currently no refbacks.