Clinical Research Directory

Inclusion Criteria: * Non resectable HCC * Initial French AFP score \< or = 2 * Registered on national waiting list for LT * Who underwent TACE as a bridge to LT * With no complete response after 2 TACE (i.e. persistent active disease, including stable disease or partial response or progression) * Non eligible for percutaneous ablation * Informed, written consent obtained from the patient * Having the rights to French social insurance * Aged of 18 years or older * 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 or 34 mcmol/l * 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 \< 50 % * Glomerular Filtration Rate (GFR) ≥ 30 mL/min/1.73 m2 * Patient with QT/QTc \< 480 ms * 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. Exclusion Criteria: * Contraindication of lenvatinib and excipient 1. Cardiovascular: * Rhythmic or ischemic recent or uncontrolled cardiac disease: Pacemakers or patients who have a history of cardiac arrhythmias or irregular heartbeats (in case of electroporation procedure) * Congestive heart failure New York Heart Association (NYHA) ≥ class 2 * Unstable angina or myocardial infarction within the past 6 months before enrolment * Uncontrolled arterial hypertension (systolic ≥ 140 mmHg, diastolic ≥ 90 mmHg) 2. Ongoing ascites: 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) 3. Coagulopathy 4. Ongoing infection \> Grade 2 according to NCI-current CTCAE . Hepatitis B is allowed if no active replication is present (below 100 IU/mL). Hepatitis C is allowed if no antiviral treatment is ongoing * Known hypersensitivity to the study drug or excipients in the formulation * Decompensated cirrhosis (Child-Pugh \> A6) * Prior systemic therapy with oral TKI and/or immunotherapy * 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 * Recent digestive bleeding associated with portal hypertension (whithin the 3 months prior to inclusion in the study) * Advanced or Metastatic HCC (BCLC C) * Persistent proteinuria of NCI-current CTCAE ≥ Grade ≥ Grade 3 * Project of living donor * Pregnant or lactating woman * Curator or guardianship or patient placed under judicial protection * Participation in other interventional research during the study. * History within the past 3 months before enrollment of haemorrhage, gastrointestinal perforation, gastrointestinal or non-gastrointestinal fistula, * History of aneurism, * Hypokalemia, hypomagnesemia and hypocalcemia