Effect of Nutritional Index on Lenvatinib Treatment Retention Rates in Unresectable Hepatocellular Carcinoma

Overview

Journal In Vivo

Specialty Oncology

Date 2025 Feb 26

PMID 40010999

Authors

Ryosuke Wakamatsu

Mizuki Nakayama

Ayaka Wakamatsu

Yuki Yamashita

Hiroo Suto

Miki Katsuragawa

Akio Shibanami

Kazuya Hiura

Affiliations

Soon will be listed here.

Abstract

Background/aim: Several studies have reported the association between lenvatinib (LEN) treatment and nutritional indices. However, no study has used multiple nutritional indices or reported their changes during treatment. This study aimed to clarify the association between LEN treatment and nutritional status.

Patients And Methods: Patients with hepatocellular carcinoma (n=103) treated with LEN were divided into two groups, namely normal and poor nutritional groups, using the Controlling Nutritional Status (CONUT) score, Onodera-Prognostic Nutritional Index (O-PNI), modified Glasgow Prognostic Score (mGPS), and Geriatric Nutritional Risk Index (GNRI). Treatment retention rates were then compared between the two groups. Additionally, changes in nutritional indices from the start of treatment to the end of the observation period or treatment were analyzed to determine their relationship with treatment continuation.

Results: Patients with normal nutrition according to the CONUT score, O-PNI, mGPS, and GNRI had a significantly higher rate of treatment retention than those with poor nutrition. Furthermore, both a normal CONUT score and mGPS indicated a lower likelihood of discontinuation due to adverse events. Patients in whom treatment was continued were significantly more likely to maintain or improve their CONUT score.

Conclusion: Maintaining or restoring a normal nutritional status is important to ensure continued treatment with LEN. Both the combination of the CONUT score and mGPS at the start of LEN treatment, and the CONUT score during treatment, are useful indicators of nutritional status.

References

Llovet J, Ricci S, Mazzaferro V, Hilgard P, Gane E, Blanc J . Sorafenib in advanced hepatocellular carcinoma. N Engl J Med. 2008; 359(4):378-90. DOI: 10.1056/NEJMoa0708857. View

Higashi T, Hayashi H, Taki K, Sakamoto K, Kuroki H, Nitta H . Sarcopenia, but not visceral fat amount, is a risk factor of postoperative complications after major hepatectomy. Int J Clin Oncol. 2015; 21(2):310-319. DOI: 10.1007/s10147-015-0898-0. View

Shimose S, Kawaguchi T, Iwamoto H, Tanaka M, Miyazaki K, Ono M . Controlling Nutritional Status (CONUT) Score is Associated with Overall Survival in Patients with Unresectable Hepatocellular Carcinoma Treated with Lenvatinib: A Multicenter Cohort Study. Nutrients. 2020; 12(4). PMC: 7231015. DOI: 10.3390/nu12041076. View

Uojima H, Chuma M, Tanaka Y, Hidaka H, Nakazawa T, Iwabuchi S . Skeletal Muscle Mass Influences Tolerability and Prognosis in Hepatocellular Carcinoma Patients Treated with Lenvatinib. Liver Cancer. 2020; 9(2):193-206. PMC: 7206580. DOI: 10.1159/000504604. View

Kudo M, Finn R, Qin S, Han K, Ikeda K, Piscaglia F . Lenvatinib versus sorafenib in first-line treatment of patients with unresectable hepatocellular carcinoma: a randomised phase 3 non-inferiority trial. Lancet. 2018; 391(10126):1163-1173. DOI: 10.1016/S0140-6736(18)30207-1. View

Kinoshita A, Hagiwara N, Osawa A, Akasu T, Matsumoto Y, Ueda K . The Geriatric Nutritional Risk Index Predicts Tolerability of Lenvatinib in Patients With Hepatocellular Carcinoma. In Vivo. 2022; 36(2):865-873. PMC: 8931877. DOI: 10.21873/invivo.12775. View

Finn R, Qin S, Ikeda M, Galle P, Ducreux M, Kim T . Atezolizumab plus Bevacizumab in Unresectable Hepatocellular Carcinoma. N Engl J Med. 2020; 382(20):1894-1905. DOI: 10.1056/NEJMoa1915745. View

Toiyama Y, Miki C, Inoue Y, Tanaka K, Mohri Y, Kusunoki M . Evaluation of an inflammation-based prognostic score for the identification of patients requiring postoperative adjuvant chemotherapy for stage II colorectal cancer. Exp Ther Med. 2012; 2(1):95-101. PMC: 3440627. DOI: 10.3892/etm.2010.175. View

de Ulibarri J, Gonzalez-Madrono A, de Villar N, Gonzalez P, Gonzalez B, Mancha A . CONUT: a tool for controlling nutritional status. First validation in a hospital population. Nutr Hosp. 2005; 20(1):38-45. View

10.

Kim B, Yu S, Kang W, Bum Cho S, Park S, Kim S . Expert consensus on the management of adverse events in patients receiving lenvatinib for hepatocellular carcinoma. J Gastroenterol Hepatol. 2021; 37(3):428-439. PMC: 9299126. DOI: 10.1111/jgh.15727. View

11.

Endo K, Kuroda H, Kanazawa J, Sato T, Fujiwara Y, Abe T . Impact of Grip Strength in Patients with Unresectable Hepatocellular Carcinoma Treated with Lenvatinib. Cancers (Basel). 2020; 12(8). PMC: 7465794. DOI: 10.3390/cancers12082146. View

12.

Onodera T, Goseki N, KOSAKI G . [Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients]. Nihon Geka Gakkai Zasshi. 1984; 85(9):1001-5. View

13.

Harimoto N, Shirabe K, Yamashita Y, Ikegami T, Yoshizumi T, Soejima Y . Sarcopenia as a predictor of prognosis in patients following hepatectomy for hepatocellular carcinoma. Br J Surg. 2013; 100(11):1523-30. DOI: 10.1002/bjs.9258. View

14.

Omiya S, Komatsu S, Kido M, Kuramitsu K, Gon H, Fukushima K . Impact of Sarcopenia as a Prognostic Factor on Reductive Hepatectomy for Advanced Hepatocellular Carcinoma. Anticancer Res. 2021; 41(11):5775-5783. DOI: 10.21873/anticanres.15394. View

15.

Forrest L, McMillan D, McArdle C, Angerson W, Dunlop D . Evaluation of cumulative prognostic scores based on the systemic inflammatory response in patients with inoperable non-small-cell lung cancer. Br J Cancer. 2003; 89(6):1028-30. PMC: 2376960. DOI: 10.1038/sj.bjc.6601242. View

16.

Bouillanne O, Morineau G, Dupont C, Coulombel I, Vincent J, Nicolis I . Geriatric Nutritional Risk Index: a new index for evaluating at-risk elderly medical patients. Am J Clin Nutr. 2005; 82(4):777-83. DOI: 10.1093/ajcn/82.4.777. View

17.

Yuri Y, Nishikawa H, Enomoto H, Ishii A, Iwata Y, Miyamoto Y . Implication of Psoas Muscle Index on Survival for Hepatocellular Carcinoma Undergoing Radiofrequency Ablation Therapy. J Cancer. 2017; 8(9):1507-1516. PMC: 5535705. DOI: 10.7150/jca.19175. View

18.

Ventura I, Sanchiz L, Legidos-Garcia M, Murillo-Llorente M, Perez-Bermejo M . Atezolizumab and Bevacizumab Combination Therapy in the Treatment of Advanced Hepatocellular Cancer. Cancers (Basel). 2024; 16(1). PMC: 10777975. DOI: 10.3390/cancers16010197. View

19.

Hiraoka A, Kumada T, Tsuji K, Takaguchi K, Itobayashi E, Kariyama K . Validation of Modified ALBI Grade for More Detailed Assessment of Hepatic Function in Hepatocellular Carcinoma Patients: A Multicenter Analysis. Liver Cancer. 2019; 8(2):121-129. PMC: 6465715. DOI: 10.1159/000488778. View

20.

Kaido T, Ogawa K, Fujimoto Y, Ogura Y, Hata K, Ito T . Impact of sarcopenia on survival in patients undergoing living donor liver transplantation. Am J Transplant. 2013; 13(6):1549-56. DOI: 10.1111/ajt.12221. View