Local Tumor Response to Conventional Transarterial Chemoembolization following Seven-day Lenvatinib Administration

Purpose: To retrospectively evaluate local tumor control and imaging findings after seven-day administration of lenvatinib followed by conventional transarterial chemoembolization in patients with unresectable hepatocellular carcinoma. Material and Methods: In this retrospective observational study, patients received lenvatinib for seven days, followed by a two-day withdrawal period, before undergoing conventional transarterial chemoembolization in routine clinical practice. The treatment efficacy of lenvatinib administration and the combination therapy was evaluated by computed tomography during hepatic arteriography and by ethiodized oil deposition on non-contrast-enhanced computed tomography after transarterial chemoembolization, respectively. Local recurrence-free survival and progression-free survival were evaluated using the Kaplan-Meier method and the modified Response Evaluation Criteria in Solid Tumors. Prognostic factors and adverse events were assessed. Results: Thirty-two patients initiated scheduled lenvatinib-transarterial chemoembolization; 25 patients with 73 nodules completed the protocol and were analyzed. Of these nodules, 56 (76.7%) showed hyperenhancement, and 17 (23.3%) showed hypoenhancement on computed tomography during hepatic arteriography. Ethiodized oil deposition with a safety margin of ≥1 mm was achieved in 60 nodules (82.2%). Local recurrence-free survival rates were 100% at three months, 91.7% at six months, and 75.9% at 12 months. Median progression-free survival was 8.0 months. Grade 3 adverse events occurred in 3 of 32 patients. Conclusions: Scheduled lenvatinib-transarterial chemoembolization demonstrated favorable local tumor control and acceptable safety in patients with unresectable hepatocellular carcinoma; however, these exploratory findings should be interpreted with caution given the single-arm retrospective design.