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Review
. 2020 Nov 28;10(11):297-306.
doi: 10.5500/wjt.v10.i11.297.

Lenvatinib as first-line therapy for recurrent hepatocellular carcinoma after liver transplantation: Is the current evidence applicable to these patients?

Federico Piñero  1 , Marcos Thompson  2 , Juan Ignacio Marín  3 , Marcelo Silva  2
Affiliations
Review

Lenvatinib as first-line therapy for recurrent hepatocellular carcinoma after liver transplantation: Is the current evidence applicable to these patients?

Federico Piñero et al. World J Transplant. .

Abstract

Liver transplantation (LT) is one of the leading curative therapies for hepatocellular carcinoma (HCC). Despite recent optimization of transplant selection criteria, including alpha-feto protein, HCC recurrence after LT is still the leading cause of death in these patients. During the last decades, effective systemic treatments for HCC, including tyrosine kinase inhibitors and immunotherapy, have been approved. We describe the clinical scenario of a patient with recurrence of HCC five years after LT, who received lenvatinib as first-line systemic therapy to introduce systemic treatment options in this clinical setting. In this opinion review, we detail first and second-line systemic treatment options, focusing on those feasible for patients with recurrent HCC after LT. Several trials have evaluated new drugs to treat HCC patients in first and second-line therapy, but patients with recurrent HCC after LT have been excluded from these trials. Consequently, most of the evidence comes from observational retrospective studies. Whether tyrosine kinase inhibitors will remain the primary therapeutic approach in these patients, due to a relative contraindication for immunotherapy, may be clarified in the near future.

Keywords: Hepatocellular carcinoma; Liver transplantation; Recurrence; Systemic therapies.

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Conflict of interest statement

Conflict-of-interest statement: Piñero F has received Advisory Board and speaker honoraria and he is a consultant for RAFFO, BAYER Cono Sur and BAYER Andina; research grants from the Argentinean National Institute of Cancer (INC ID-190), Argentinean National Ministry of Science and Technology Development (PICT 2017, FONCYT) and from the Latin American Liver Research Educational and Awareness Network (LALREAN). Marin J has received Advisory Board and speaker honoraria from BAYER and GILEAD. Silva M has received speaker honoraria and is a consultant for Abvie, Gador, Bristol-Myers Squibb, Merck, BAYER and has received research grants from the Argentinean National Institute of Cancer (INC ID-190), and the Argentinean National Ministry of Science and Technology Development (PICT 2017, FONCYT).

Figures

Figure 1
Figure 1
Metastatic site of hepatocellular recurrence after liver transplantation in a patient who received lenvatinib.
Figure 2
Figure 2
First- and second-line therapies for advanced hepatocellular carcinoma that may be applicable in the post-liver transplantation setting.
See this image and copyright information in PMC

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