Sonazoid-enhanced ultrasound for predicting therapeutic effect of lenvatinib against hepatocellular carcinoma

Abstract

Introduction Recently, a multi-targeted tyrosine kinase inhibitor, lenvatinib, was approved as first-line therapy for unresectable hepatocellular carcinoma (HCC). Lenvatinib exerts antitumor activity by inhibiting angiogenesis through blockage of the VEGF and FGF pathway. Contrast-enhanced CT (CECT) is generally used for evaluation of therapeutic effect of lenvatinib; however, CECT is unsuitable for frequent monitoring. We aimed to evaluate the feasibility of Sonazoid-enhanced ultrasound (SEUS) for predicting therapeutic effect of lenvatinib. Methods Among patients with HCC who started treatment with lenvatinib in hour hospital, five cases who could receive time intensity curve (TIC) analysis by SEUS using LOGIQ E9 (GE Healthcare) were enrolled in this study. We compared the results of TIC analysis within 1 month after treatment initiation and first CECT after 2-3 months. Results The reduction rate of tumor blood flow by SEUS-TIC analysis within 1 month after treatment initiation and the evaluation of treatment response by first CECT after 2-3 months showed high correlation. However, SEUS-TIC analysis was applicable to limited cases who have a hypervascular nodule that can be visualized and measured stably with US and can stably hold breath. Conclusion Our findings suggest the utility of TIC analysis by SEUS for predicting therapeutic effect of lenvatinib against HCC in appropriate cases.