AIM: To elucidate influencing factors of treatment response, then tolvaptan has been approved in Japan for liquid retention.METHODS: We herein conducted this study to clarify the influencing factors in 40 patients wit...AIM: To elucidate influencing factors of treatment response, then tolvaptan has been approved in Japan for liquid retention.METHODS: We herein conducted this study to clarify the influencing factors in 40 patients with decompensated liver cirrhosis complicated by liquid retention. Tolvaptan was administered at a dosage of 7.5 mg once a day for patients with conventional diuretic-resistant hepatic edema for 7 d. At the initiation of tolvaptan, the estimated hepatic venous pressure gradient (HVPG) value which was estimated portal vein pressure was measured using hepatic venous catheterization. We analyzed the effects of tolvaptan and influencing factors associated with treatment response.RESULTS: Subjects comprised patients with a median age of 65 (range, 40-82) years. According to the Child-Pugh classification, class A was 3 patients, class B was 19, and class C was 18. Changes from the baseline in body weight were -1.0 kg (P = 2.04 × 10<sup>-6</sup>) and -1.3 kg (P = 1.83 × 10<sup>-5</sup>), respectively. The median HVPG value was 240 (range, 105-580) mmH<sub>2</sub>O. HVPG was only significant influencing factor of the weight loss effect. When patients with body weight loss of 2 kg or greater from the baseline was defined as responders, receiver operating characteristic curve analysis showed that the optimal HVPG cutoff value was 190 mmH<sub>2</sub>O in predicting treatment response. The response rate was 87.5% (7/8) in patients with HVPG of 190 mmH<sub>2</sub>O or less, whereas it was only 12.5% (2/16) in those with HVPG of greater than 190 mmH<sub>2</sub>O (P = 7.46 × 10<sup>-4</sup>). We compared each characteristics factors between responders and non-responders. As a result, HVPG (P = 0.045) and serum hyaluronic acid (P = 0.017) were detected as useful factors.CONCLUSION: The present study suggests that tolvaptan in the treatment of liquid retention could be more effective for patients with lower portal vein pressure.展开更多
Background:Lenvatinib is used for unresectable hepatocellular carcinoma(u-HCC)as first-line,as well as second-and third-line therapy in Japan.We evaluated the therapeutic efficacy of newly developed ramucirumab when g...Background:Lenvatinib is used for unresectable hepatocellular carcinoma(u-HCC)as first-line,as well as second-and third-line therapy in Japan.We evaluated the therapeutic efficacy of newly developed ramucirumab when given after lenvatinib for post-progression treatment.Methods:Of 385 patients with u-HCC and treated with lenvatinib at 16 different institutions in Japan between May 2018 and January 2020,28 who received ramucirumab as the next treatment were enrolled and therapeutic responses were evaluated in a retrospective manner.Results:The median age of the 28 patients given ramucirumab was 70 years and the median albumin-bilirubin score was-2.19.Of the 28 patients,23 were male,21 were classified as Child-Pugh A and 7 as Child-Pugh B,and 25 were Barcelona Clinic Liver Cancer Stage C.Ramucirumab was given as second-line therapy in 14,third-line in 9,and fourth-line in 5.Therapeutic response was obtained in only 26 patients;the objective response rate was 3.8%(1/26)and the disease-control rate was 42.3%(11/26),with a median period to progression of 2.0 months.The reasons for discontinuation of ramucirumab were progression of disease in 16 and Grade 3 adverse events(gastrointestinal bleeding,ascites)in 2.Conclusions:The anticipated therapeutic efficacy of ramucirumab for post-progression treatment following lenvatinib was not seen in our early experience.展开更多
文摘AIM: To elucidate influencing factors of treatment response, then tolvaptan has been approved in Japan for liquid retention.METHODS: We herein conducted this study to clarify the influencing factors in 40 patients with decompensated liver cirrhosis complicated by liquid retention. Tolvaptan was administered at a dosage of 7.5 mg once a day for patients with conventional diuretic-resistant hepatic edema for 7 d. At the initiation of tolvaptan, the estimated hepatic venous pressure gradient (HVPG) value which was estimated portal vein pressure was measured using hepatic venous catheterization. We analyzed the effects of tolvaptan and influencing factors associated with treatment response.RESULTS: Subjects comprised patients with a median age of 65 (range, 40-82) years. According to the Child-Pugh classification, class A was 3 patients, class B was 19, and class C was 18. Changes from the baseline in body weight were -1.0 kg (P = 2.04 × 10<sup>-6</sup>) and -1.3 kg (P = 1.83 × 10<sup>-5</sup>), respectively. The median HVPG value was 240 (range, 105-580) mmH<sub>2</sub>O. HVPG was only significant influencing factor of the weight loss effect. When patients with body weight loss of 2 kg or greater from the baseline was defined as responders, receiver operating characteristic curve analysis showed that the optimal HVPG cutoff value was 190 mmH<sub>2</sub>O in predicting treatment response. The response rate was 87.5% (7/8) in patients with HVPG of 190 mmH<sub>2</sub>O or less, whereas it was only 12.5% (2/16) in those with HVPG of greater than 190 mmH<sub>2</sub>O (P = 7.46 × 10<sup>-4</sup>). We compared each characteristics factors between responders and non-responders. As a result, HVPG (P = 0.045) and serum hyaluronic acid (P = 0.017) were detected as useful factors.CONCLUSION: The present study suggests that tolvaptan in the treatment of liquid retention could be more effective for patients with lower portal vein pressure.
文摘Background:Lenvatinib is used for unresectable hepatocellular carcinoma(u-HCC)as first-line,as well as second-and third-line therapy in Japan.We evaluated the therapeutic efficacy of newly developed ramucirumab when given after lenvatinib for post-progression treatment.Methods:Of 385 patients with u-HCC and treated with lenvatinib at 16 different institutions in Japan between May 2018 and January 2020,28 who received ramucirumab as the next treatment were enrolled and therapeutic responses were evaluated in a retrospective manner.Results:The median age of the 28 patients given ramucirumab was 70 years and the median albumin-bilirubin score was-2.19.Of the 28 patients,23 were male,21 were classified as Child-Pugh A and 7 as Child-Pugh B,and 25 were Barcelona Clinic Liver Cancer Stage C.Ramucirumab was given as second-line therapy in 14,third-line in 9,and fourth-line in 5.Therapeutic response was obtained in only 26 patients;the objective response rate was 3.8%(1/26)and the disease-control rate was 42.3%(11/26),with a median period to progression of 2.0 months.The reasons for discontinuation of ramucirumab were progression of disease in 16 and Grade 3 adverse events(gastrointestinal bleeding,ascites)in 2.Conclusions:The anticipated therapeutic efficacy of ramucirumab for post-progression treatment following lenvatinib was not seen in our early experience.
