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Objective: Lenvatinib is considered the first-line treatment for unresectable advanced hepatocellularcarcinoma (HCC); however, in some clinical cases, discontinuation of lenvatinib is unavoidable. It isimportant to elucidate if transcatheter arterial infusion (TAI) with drug-eluting beads transarterialchemoembolization (DEB-TACE) is a feasible second-line treatment after discontinuing lenvatinib. In thisstudy, we aimed to evaluate the efficacy, hepatic function and nutritional status associated with TAI withDEB-TACE for patients who previously discontinued lenvatinib.Materials and Methods: We included 35 patients who were prescribed lenvatinib for unresectable HCCbetween July 2018 and December 2019, of whom 12 discontinued lenvatinib during the study. The changesin the albumin-bilirubin (ALBI) score and the controlling nutritional status (CONUT) score before and afterdiscontinuing lenvatinib were examined. Furthermore, the tolerability and survival of patients treated usingTAI with DEB-TACE as a second-line treatment were analysed.Results: The ALBI and CONUT scores were significantly worse when lenvatinib was started and stopped(p&lt;0.05). The CONUT score was significantly worse in the second-line group than in the follow-up groupwhen beginning and discontinuing lenvatinib; however, this score tended to improve after DEB-TACE. Thegroup that underwent TAI with DEB-TACE as a second-line treatment had significantly better survival thanthe follow-up group (log‑rank test, p=0.029; generalized Wilcoxon test, p=0.042).Conclusion: In patients who could undergo TAI with DEB-TACE as a second-line treatment afterdiscontinuing lenvatinib, the CONUT score improved, while the ALBI score was maintained and welltolerated; these scores may have contributed to improved survival compared with follow-up patients. Futurestudies with larger sample sizes are necessary to confirm our findings.

clinical oncology and research

Additional Treatment Using Transcatheter Arterial Infusion with Drug-Eluting Beads Transarterial Chemoembolization Contributes to Prolonged Survival of Patients with BCLC Stage C Hepatocellular Carcinoma after Discontinuing Lenvatinib: Preliminary Study