Published online May 21, 2019. doi: 10.3748/wjg.v25.i19.2365
Peer-review started: February 12, 2019
First decision: March 20, 2019
Revised: April 12, 2019
Accepted: April 29, 2019
Article in press: April 29, 2019
Published online: May 21, 2019
Lenvatinib is one of the ﬁrst-line tyrosine kinase inhibitors used for unresectable hepatocellular carcinoma (HCC).
The overall prognosis for patients with HCC is poor, and more than half of the patients are diagnosed at a stage when the tumor is unresectable. The treatment options for unresectable HCC are limited, and oral administration of sorafenib, a receptor tyrosine kinase inhibitor, has been the only treatment that substantially prolongs survival.
To evaluate the potential of the early changes in the time-intensity curve (TIC) of contrast-enhanced ultrasound (CEUS) as early imaging biomarkers of lenvatinib efficacy in patients with unresectable HCC.
We analyzed 20 consecutive patients with unresectable HCC treated with lenvatinib from March to November 2018. Tumor response at 8 wk was assessed by computed tomography using the modiﬁed Response Evaluation Criteria in Solid Tumors (mRECIST). CEUS was performed at baseline before treatment (Day 0) and on day 7 (Day 7), and the images were analyzed in the arterial phase for 20 seconds after the contrast agent arrived at the target tumor. Three perfusion parameters were extracted from the TICs: the slope of wash-in (Slope), time to peak (TTP) intensity, and the total area under the curve (AUC) during wash-in. The rate of change in the TIC parameters between Day 0 and Day 7 was compared between treatment responders and non-responders based on mRECIST.
The rate of change for all TIC parameters showed significant differences between the responders (n = 9) and non-responders (n = 11) (Slope, P = 0.025; TTP, P = 0.004; and AUC, P = 0.0003). The area under the receiver operating curve values for slope, TTP, and AUC for the prediction of responders were 0.805, 0.869, and 0.939, respectively.
To the best of our knowledge, this is the first prospective study to assess the potential of CEUS for making early predictions of outcomes following lenvatinib therapy, which makes it a significant contribution to the literature.
Further, we believe that this paper will be of interest to the readership especially hepatologists and oncologists because we demonstrate that CEUS may be useful for the early prediction of tumor response in patients with unresectable HCC treated with lenvatinib.