Patients with advanced hepatocellular carcinoma (HCC) undergoing molecular targeted therapy often experience non-negligible adverse events (AEs). Paradoxically, certain AEs are reportedly associated with a good prognosis. We aimed to identify factors predictive of treatment duration and overall survival (OS) in patients with HCC undergoing lenvatinib therapy. Forty-six consecutive patients with advanced HCC who received lenvatinib therapy from April 2018 to November 2019 were prospectively followed until November 2019. Treatment efficacy was assessed according to the modified Response Evaluation Criteria in Solid Tumors for 2–3 months after therapy initiation. The disease control rate (DCR) was defined as the percentage of patients with a complete response, partial response, or stable disease. The DCR was 65.2%, with a median survival of 10.2 months. Grade 2/3 hypoalbuminemia resulted in shorter treatment duration. Factors predictive of longer OS were a Child-Pugh score of 5 at baseline and the occurrence of Grade 2/3 hypothyroidism. Conversely, Grade 2/3 hypoalbuminemia was associated with a poorer prognosis. An AE of Grade 2/3 hypothyroidism was associated with a better prognosis in patients receiving lenvatinib treatment for advanced HCC. Continuing anticancer therapy with appropriate thyroid hormone replacement may contribute to longer OS.

This study aimed to identify the health-related quality of life (HRQOL) domains associated with prognosis by assessing longitudinal alterations in HRQOL in patients with advanced hepatocellular carcinoma receiving sorafenib. We prospectively assessed HRQOL by administering the SF-36 questionnaire 3-monthly to consecutive patients with advanced hepatocellular carcinoma receiving sorafenib. We evaluated the impact of HRQOL on their overall survival and duration of treatment with sorafenib using Cox's proportional hazards model. There were 54 participants: 42 (78 %) were male, the median age was 71 years, 24 (44 %) had hepatitis C virus infection, 33 (61 %) had Child-Pugh scores of 5, and 30 (56 %) had TNM stage IV hepatocellular carcinoma. The median overall survival and treatment duration were 9 and 5 months, respectively, and 40 patients (74 %) died. Thirteen patients receiving sorafenib over a 1-year period maintained all domain scores >40, without a significant decline during the treatment period. In contrast, physical functioning, physical role, and vitality scores declined continuously and significantly in the year before death (in the 40 patients who died). Previous curative treatment and physical functioning scores ≥40 at baseline were significantly associated with longer overall survival by multivariate analysis. Social functioning scores ≥40, absence of vascular invasion, and lower DCP value were significant predictors of longer treatment duration. HRQOL was not significantly impaired in those patients who were able to complete a 1-year course of sorafenib treatment. Baseline physical functioning scores ≥40 and social functioning scores ≥40 were significantly associated with longer overall survival and longer treatment duration, respectively. Thus, HRQOL could be a valuable marker to predict the clinical course of patients with advanced hepatocellular carcinoma receiving sorafenib.

Background/Objectives: Health-related quality of life (HRQoL) is critical in patients with hepatocellular carcinoma (HCC). It has become a key endpoint in the evaluation of new therapies, including atezolizumab + bevacizumab (Atezo + Bev) therapy. Methods: This study explored the factors associated with treatment efficacy, treatment duration, and overall survival (OS) in patients with advanced HCC undergoing Atezo + Bev therapy. We included 58 consecutive patients with HCC receiving Atezo + Bev from 19 November 2020, to 28 December 2023, who were followed up until the end of the study or death. We analyzed the relationships between baseline characteristics, adverse events (AEs), and HRQoL and efficacy, OS, and treatment duration. Results: The demographic (older men) and baseline characteristics (Child–Pugh score of 5, Barcelona Clinic Liver Cancer Stage C) were consistent with those of previous studies. The treatment demonstrated promising efficacy with a disease control rate of 71.2%, but HRQoL scores in five functional domains and seven symptoms worsened significantly within the first 3 months. Notably, better baseline cognitive and physical function scores and absence of severe (grade ≥ 2) hypoalbuminemia were associated with an improved objective response rate, longer treatment duration, and better OS. Conclusions: These findings underscore the importance of monitoring and managing treatment-related AEs and maintaining the HRQoL. They also highlight the crucial and reassuring role of multidisciplinary care in enhancing treatment outcomes in this cohort.

Background: Patients undergoing major surgery often experience “post-operative dysfunction”, which may affect their physical strength and mental activity for a significant period post-operatively. We aimed to clarify the post-operative changes in physical activity, quality of life, and self-efficacy in patients with gastric cancer. Methods: Physical activity, health-related quality of life, and self-efficacy were assessed in subjects using self-administered questionnaires before surgery, at discharge, and 1, 3, and 6 months after discharge. Post-operative parameters were compared to baseline data using the Friedman test with Bonferroni correction, as well as the Wilcoxon two-sample test. Results: Seventeen subjects were included. Dietary intake and number of steps walked significantly decreased for up to 1 month after discharge, whereas physical activity of ≥3 metabolic equivalents of task and exercise-expended energy were lowest at discharge. These differences were all statistically significant. Importantly, the patients did subsequently improve. Body mass index did not differ significantly at discharge, but showed a gradual, significant decrease at 1 and 3 months after discharge. With respect to health-related quality of life, the physical, role, and social functions decreased significantly for a month after surgery, whereas symptoms of fatigue, anorexia, and diarrhea were significantly severe during the first month after discharge. Self-efficacy in terms of symptoms, activities of daily living, and disease status significantly decreased at discharge, but subsequently improved. Conclusions: Patients with gastric cancer showed lower dietary intake and body mass index up to 1 and 3 months after discharge, respectively. Physical activity and self-efficacy were lowest at discharge but improved subsequently. It is necessary, both preoperatively and in the first month following discharge, to provide patients with support that encourages self-management of physical changes and symptoms, and a return to normal levels of physical activity.

Aim: This study aimed to comprehensively assess the incidence of immune‐related adverse events (irAEs) and the detection systems in place for patients with liver cancer undergoing treatment with immune checkpoint inhibitors (ICIs), using a self‐administered anonymous questionnaire. The questionnaire was designed to gather crucial insights into the management of irAEs in these patients.Methods: A self‐administered anonymous questionnaire was sent to 456 liver disease collaborative base hospitals and cancer care coordination base hospitals in Japan.Results: Responses were received from 112 facilities, indicating a response rate of 25%. The region with the highest response rate was Kanto (22%, 24 sites), followed by Kyushu (19%, 21 sites), Chubu (14%, 15 sites), and Kinki (14%, 15 sites). The number of patients with hepatocellular carcinoma (HCC) who received ICI treatment varied, with a mean ± SD of 20.4 ± 19.4 cases per year per facility. The number of full‐time physicians who provided ICI treatment for HCC was 4.2 ± 3.3 (mean ± SD), ranging from 0 to 24 per facility. Of these, the majority included hepatologists and oncologists, whose numbers were 3.3 ± 2.4 (mean ± SD) (range, 0–11) and 0.8 ± 1.0 (0–3), respectively. Gastroenterologists and internal medicine specialists participated in the treatment at some facilities.Conclusions: The survey results revealed that physicians administered ICI therapy for an average of 20 HCC cases per institution, with more than 17 types of irAEs reported. The most common irAEs were hepatic dysfunction, followed by thyroid dysfunction, skin disorders, interstitial pneumonia, and renal dysfunction.

症例は81歳男性．肝細胞癌に対して，2007年に肝S7亜区域切除，肝S5の再発に対して2013年4月，12月にRFAを施行．その後肝内再発は認めなかったが，椎骨と肺に多発転移を認めたため，2014年1月よりソラフェニブを800 mg/日で開始した．手足症候群の出現により400 mg/日まで減量したところ，AFPの上昇（59716 ng/ml），肝内再発，転移巣の増大を認めた．その後，ソラフェニブの副作用は軽快傾向にあったため，2015年7月より600 mg/日に増量したところ，転移巣は著明に縮小し，2016年6月にはAFP 16 ng/mlと正常化を認めた．ソラフェニブは副作用を懸念し400 mg/日で開始する場合も多い．しかしながら，本症例のように増量で著明な抗腫瘍効果が得られる症例も存在するため，たとえ減量後であっても忍容性をみながら増量することを考慮すべきである．