ObjectiveThis study aimed to assess the efficacy and safety of camrelizumab plus apatinib in patients with resectable hepatocellular carcinoma (HCC) as neoadjuvant therapy.MethodsInitially, 20 patients with HCC were screened and 18 patients with resectable HCC were enrolled in this open-label, single-arm, phase II clinical trial. Patients received three cycles of neoadjuvant therapy including three doses of camrelizumab concurrent with apatinib for 21 days followed by surgery. Four to 8 weeks after surgery, patients received eight cycles of adjuvant therapy with camrelizumab in combination with apatinib. Major pathological reactions (MPR), complete pathological reactions (pCR), objective response rate (ORR), relapse-free survival (RFS), and adverse events (AE) were assessed. In addition, cancer tissue and plasma samples were collected before and after treatment, and genetic differences between responding and non-responding lesions were compared by tumor immune microenvironment (TIME) analysis, circulating tumor DNA (ctDNA) analysis and proteomics analysis.ResultsIn 18 patients with HCC who completed neoadjuvant therapy, 3 (16.7%) and 6 (33.3%) patients with HCC reached ORR based on Response Evaluation Criteria in Solid Tumors (RECIST) V.1.1 and modified RECIST criteria, respectively. Of the 17 patients with HCC who received surgical resection, 3 (17.6%) patients with HCC reported MPR and 1 (5.9%) patient with HCC achieved pCR. The 1-year RFS rate of the enrolled patients was 53.85% (95% CI: 24.77% to 75.99%). Grade 3/4 AEs were reported in 3 (16.7%) of the 18 patients, with the most common AEs being rash (11.1%), hypertension (5.6%), drug-induced liver damage (5.6%), and neutropenia (5.6%) in the preoperative phase. The 289 NanoString panel RNA sequencing showed that TIME cell infiltration especially dendritic cells (DCs) infiltration was better in responding tumors than in non-responding tumors. Our results of ctDNA revealed a higher positive rate (100%) among patients with HCC with stage IIb–IIIa disease. When comparing patients with pCR/MPR and non-MPR, we observed more mutations in patients who achieved pCR/MPR at baseline (6 mutations vs 2.5 mutations, p=0.025). Patients who were ctDNA positive after adjuvant therapy presented a trend of shorter RFS than those who were ctDNA negative. Proteomic analysis suggested that abnormal glucose metabolism in patients with multifocal HCC might be related to different sensitivity of treatment in different lesions.ConclusionPerioperative camrelizumab plus apatinib displays a promising efficacy and manageable toxicity in patients with resectable HCC. DCs infiltration might be a predictive marker of response to camrelizumab and apatinib as well as patients’ recurrence. ctDNA as a compose biomarker can predict pathological response and relapse. Abnormal glucose metabolism in patients with multifocal HCC may be related to different sensitivity of treatment in different lesions.Trial registration numberNCT04297202.

Exosome-encapsulated microRNAs have been recognized as novel and stable biomarkers for cancer. However, little is known about the role of exosomal microRNAs in colon cancer. In the present study, we investigated the expression of serous exosomal microRNA-638 (miR-638) and its prognostic effect in patients with colon cancer. Serous exosomal samples were assayed by quantitative real-time PCR. Kaplan-Meier analysis was adopted to determine the overall survival (OS) and disease-free survival (DFS) of colon cancer patients. Cox regression analysis was applied to assess the potential association between serous exosomal miR-638 and clinicopathological factors of colon cancer patients. MiR-638 was significantly reduced in serum exosomes of colon cancer patients compared with healthy controls. Decreased level of serous exosomal miR-638 was more significant in colon cancer patients at later TNM stage or with liver metastasis. Kaplan-Meier analysis showed that colon cancer patients with reduced level of serous exosomal miR-638 had poor OS and DFS. In addition, the Cox regression analysis suggested serous exosomal miR-638 was a prognostic factor for colon cancer independent of TNM stage and liver metastasis. In conclusion, serous exosomal miR-638 is a useful biomarker for the prediction of colon cancer prognosis.

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