Cancer pill may boost ablation success in aggressive liver tumors

Copied word for word from the study's registry entry, so the wording is the study team's rather than ours.

Inclusion Criteria: * Male or female patients ≥ 18 years * Histological or radiological diagnosis of HCC, whether new or recurrent following a prior curative therapeutic management \> 6 months. * Barcelona Clinical Liver Cancer (BCLC) stage Category A * Comprising at least one of the following the following characteristics: * Single tumour\>3 cm≤ 5cm or * Multiple tumours (max 3 lesions ≤ 3cm) or * Single tumour between 2 and 3 cm with at least one of the following characteristic: * Serum AFP\>100 ng/mL * Infiltrative form * Macro-trabecular subtype (if applicable) * Patients with HCC amenable for PA as assessed by multidisciplinary board * At least one uni-dimensional measurable lesion by computed tomography (CT) scan or magnetic resonance imaging (MRI) according to modified RECIST for HCC * Absence of any portal vein thrombosis * Liver function status Child-Pugh Class A * Eastern Cooperative Oncology Group (ECOG) Performance Status ≤ 1 * Adequate bone marrow, liver and renal function as assessed by the following laboratory tests: * Hemoglobin \> 8.5 g/dL * Absolute neutrophil count ≥ 1500/mm3 (≥ 1200/mm3 for black/African, American) * Platelet count ≥ 60,000/ mm3 * Total bilirubin ≤ 2 mg/dL * Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤ 5 x upper limit of normal (ULN) * Serum creatinine ≤ 1.5 x ULN * Prothrombine time-international normalized ratio (PT-INR) \< 2.3 and PTT \< 1.5 * Glomerular Filtration Rate (GFR) ≥ 30 mL/min/1.73 m2 * Life expectancy ≥ 3 months * Women of childbearing potential (WOCBP) need to accept one effective method of contraception until 1 month after the last lenvatinib intake and avoid pregnancy * Patients who are sexually active with WOCBP partners need to accept one effective method of contraception until 1 month after lenvatinib intake and men must agree to use adequate contraception * Patients affiliated to a Social Security System * Written informed consent signed * Patient under guardianship or curatorship\* * Satisfactory nutritional status (BMI\>18 kg/m² for patients under 70 years old, or ≥21 kg/m² for the patients over 70 years old) * Patient under guardianship or curatorship\* Exclusion Criteria: * Patients with recurrence of HCC occurring less than six months after a curative treatment regarded as successful * BCLC stage \>A (1 single lesion \>5cm or more than 3 lesions ore multifocal HCC \>3cm or vascular invasion or extra-hepatic spread) * Patients with contraindications to PA * Pacemakers or patients who have a history of cardiac arrhythmias or irregular heartbeats (in case of electroporation procedure) * Ascites * Coagulopathy * Ongoing bacterial infection * Patients with contraindication to contrast medium intravenous injection either gadolinium or iodinate * Prior liver transplantation * Prior systemic treatment for HCC (chemotherapy, any other TKI, immunotherapy) * Patients with large esophageal varices at risk of bleeding that are not being treated with conventional medical intervention * Past or concurrent history of neoplasm other than HCC, except for in situ carcinoma of the cervix uteri and/or non-melanoma skin cancer and superficial bladder tumours. Any cancer curatively treated \> 3 years prior to study entry is permitted * Major surgical procedure or significant traumatic injury within 28 days before enrolment * Congestive heart failure New York Heart Association (NYHA) ≥ class 2 * Unstable angina or myocardial infarction within the past 6 months before enrolment * Uncontrolled blood pressure to systolic BP \>140mmHg or diastolic BP \>90 mmHg in spite of an optimized regimen of antihypertensive medication. * Patients with phaeochromocytoma * Refractory ascites according to EASL guidelines definition (ascites that cannot be mobilized or the early recurrence of which cannot be prevented because of a lack of response to sodium restriction and diuretic treatment) * Persistent proteinuria of NCI-CTCAE version 4.0 ≥ Grade 3 * Ongoing infection \> Grade 2 according to NCI-CTCAE version 4.0. Hepatitis B is allowed if no active replication is present (below 100 IU/mL). Hepatitis C is allowed if no antiviral treatment is required * Clinically significant bleeding NCI-CTCAE version 4.0 ≥ Grade 3 within 30 days before enrolment * Any psychological, familial, sociological, geographical or illness or medical condition that could jeopardize the safety of the patient and/or his compliance with the study protocol and follow-up procedure * Non-healing wound, ulcer or bone fracture * Known hypersensitivity to the study drug or excipients in the formulation * Any malabsorption condition * Breast feeding * Pregnancy * Patient unable to swallow oral medication