176P Effect of adjuvant lenvatinib (LEN) on tumour recurrence in patients with hepatocellular carcinoma (HCC) and high residual alpha-fetoprotein (AFP) following resection or ablation: A single-center, retrospective study

In China, surgical resection and ablation are widely used to treat HCC; however, relapse rates are high for patients with residual elevated AFP 2 months post-treament. LEN has been shown to reduce AFP levels in patients with advanced HCC. We therefore investigated the efficacy of LEN for preventing recurrence in patients with HCC and elevated AFP after surgery or ablation. This single-center, retrospective study, conducted between Nov 2018 and Jan 2020, included medical records from 84 patients with HCC who achieved complete radiologic response following resection or radiofrequency ablation, had high residual AFP (>20 ng/mL) 8 weeks post-surgery and received LEN according to local labelling (n=23), adjuvant transarterial chemoembolization (TACE; n=25) or no treatment (Control group, n=36). A further group of patients with HCC R0 resection (AFP negative post-surgery) was also included (n=22). AFP response was defined as >20% reduction in AFP ≤8 weeks from initiation of LEN. Recurrence free survival (RFS) was calculated from initiation of treatment (LEN and TACE groups) or the date of surgery (Control and R0 groups) until first confirmed local, regional or distant tumor recurrence. Median follow-up in all patients was 11.2 months. Patient baseline characteristics were similar between groups, except for baseline BCLC stage. Among patients receiving LEN, 61% (14/23) achieved an AFP response. The rate of 1-year RFS was higher for patients in the LEN group who achieved an AFP response (71.4% [10/14]) compared with the TACE (36.0% [9/25]) and Control (50.0% [18/36]) groups. Median RFS had not been reached in the LEN, TACE, and R0 groups. At data cutoff, 9 (64.3%) patients receiving LEN who achieved an AFP response were recurrence free, and follow-up is on-going. LEN led to an AFP response in 61% of patients with HCC and residual elevated AFP post surgery/ablation, and this was associated with a high 1-year RFS. Therefore, AFP response may provide a biomarker to predict response to LEN in this setting and further investigation in prospective trials is warranted.