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

Authors

  • Alifia Sabira Putri Faculty of Medicine and Health Science, University of Mataram, Mataram, Indonesia
  • Rovera Nuriasti Faculty of Medicine and Health Science, University of Mataram, Mataram, Indonesia
  • Balqis Prudena Kurnia Pambudi Faculty of Medicine and Health Science, University of Mataram, Mataram, Indonesia
  • Naufal Revaldy Fauzan Faculty of Medicine and Health Science, University of Mataram, Mataram, Indonesia
  • Baiq Zaskia Maudina Faculty of Medicine and Health Science, University of Mataram, Mataram, Indonesia
  • Yoga Prawira Faculty of Medicine and Health Science, University of Mataram, Mataram, Indonesia
  • Anak Agung Ayu Regina Larasati Faculty of Medicine and Health Science, University of Mataram, Mataram, Indonesia
  • Catarina Budyono Faculty of Medicine and Health Science, University of Mataram, Mataram, Indonesia

DOI:

https://doi.org/10.24871/2622025168-175

Keywords:

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

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.

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.

Downloads

Published

2025-08-15

How to Cite

Putri, A. S., Nuriasti, R., Pambudi, B. P. K., Fauzan, N. R., Maudina, B. Z., Prawira, Y., … Budyono, C. (2025). Effectiveness of Combination Therapy of Stereotactic Body Radiation Therapy with Lenvatinib in Advanced Hepatocellular Carcinoma. The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy, 26(2), 168–175. https://doi.org/10.24871/2622025168-175

Issue

Vol. 26 No. 2 (2025): VOLUME 26, NUMBER 2, August, 2025

Section

Review Article

License

Authors who publish with this journal agree to the following terms:

a. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.

b. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.

c. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).