Combination of Sorafenib, Camrelizumab, Transcatheter Arterial Chemoembolization, and Stereotactic Body Radiation Therapy as a Novel Downstaging Strategy in Advanced Hepatocellular Carcinoma With Portal Vein Tumor Thrombus: A Case Series Study

Huang, Yun; Zhang, Zeyu; Liao, Weijun; Hu, Kuan; Wang, Zhiming

doi:10.3389/fonc.2021.650394

Cited by 20 publications

(19 citation statements)

References 28 publications

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“…In terms of the safety findings, previous studies of patients with intermediate to advanced HCC treated with PD-1 inhibitor plus TACE indicated that the most common adverse events included fever, skin reactions, fatigue, vomiting, hypertension, diarrhea, thrombocytopenia, elevated AST, elevated ALT, asthenia, decreased appetite, rash, and pruritus ( 12 , 28 ). Consistent with previous studies, we found that the incidence of total AEs was 90.1%.…”

Section: Discussionmentioning

confidence: 99%

“…Camrelizumab, a PD-1 inhibitor, was independently developed by Jiangsu Hengrui Pharmaceuticals Co., Ltd. in China and has recently been approved by the Chinese Food and Drug Administration (CFDA) to treat hepatocellular carcinoma. A few studies have exhibited the efficacy of camrelizumab in patients with advanced HCC (12)(13)(14). For instance, a study disclosed that a combination of camrelizumab with sorafenib, TACE, and radiotherapy in treating advanced HCC patients with portal vein tumor thrombus achieved a median PFS of 15.7 months and a 1year OS of 83.3% (12).…”

Section: Introductionmentioning

confidence: 99%

“…A few studies have exhibited the efficacy of camrelizumab in patients with advanced HCC (12)(13)(14). For instance, a study disclosed that a combination of camrelizumab with sorafenib, TACE, and radiotherapy in treating advanced HCC patients with portal vein tumor thrombus achieved a median PFS of 15.7 months and a 1year OS of 83.3% (12). Another study demonstrated that camrelizumab plus lenvatinib had a median PFS of 8.0 months in advanced HCC patients, which is higher than patients who received lenvatinib only (13).…”

Section: Introductionmentioning

confidence: 99%

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Efficacy and safety of camrelizumab plus transarterial chemoembolization in intermediate to advanced hepatocellular carcinoma patients: A prospective, multi-center, real-world study

You

Wang

et al. 2022

Front. Oncol.

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ObjectiveCamrelizumab is a newly developed program-death receptor one inhibitor; the real-world evidence about its application in hepatocellular carcinoma (HCC) treatment is lacking. Therefore, this prospective, multi-center, real-world study evaluated the efficacy and safety of camrelizumab plus transarterial chemoembolization (TACE) in treating intermediate-to-advanced HCC patients.MethodsThis study consecutively enrolled 101 intermediate to advanced HCC patients. All patients received camrelizumab-based treatment within 30 days of the perioperative period of the TACE operation. The primary outcome was progression-free survival (PFS), and the secondary effects were overall survival (OS), objective response rate (ORR), disease control rate (DCR), and AEs.ResultsSpecifically, the median PFS was 9.7 (95% confidence interval: 7.4–12.0) months, with a 1-year PFS rate of 30.6%. Meanwhile, the median OS was not reached (NR) yet, with a 1-year OS rate of 61.9%. Besides, the CR, PR, SD, and PD rates were 12.8%, 44.9%, 29.5%, and 12.8%, respectively. The ORR and DCR were 57.7% and 87.2%, respectively. More cycles of camrelizumab were independently correlated with prolonged PFS (hazard ratio (HR): 0.415, P = 0.002), whereas longer intervals between camrelizumab administration and TACE were independently associated with unfavorable PFS (HR: 1.873, P = 0.032). The incidence of total AEs was 90.1%; most AEs were grade 1 (20.8%), grade 2 (28.7%) and grade 3 (37.6%), while only 3 (3.0%) patients had grade 4 AEs.ConclusionThe camrelizumab plus TACE regimen is effective and safe, indicating its potential to serve as a promising treatment choice for intermediate to advanced HCC patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Efficacy and safety of camrelizumab plus transarterial chemoembolization in intermediate to advanced hepatocellular carcinoma patients: A prospective, multi-center, real-world study

You

Wang

et al. 2022

Front. Oncol.

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“…Recently, Huang et coll. [ 105 ] published a case series including 13 advanced HCC patients with portal vein tumour thrombosis receiving the combination therapy of sorafenib, camrelizumab, transcatheter arterial chemoembolisation and stereotactic body radiation therapy, showing macrovascular invasion regression in 33% of cases. Responder patients underwent hepatectomy.…”

Section: Upper Limits For Downstaging?mentioning

confidence: 99%

Upper Limits of Downstaging for Hepatocellular Carcinoma in Liver Transplantation

Biolato

Galasso

Marrone

et al. 2021

Cancers

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In Europe and the United States, approximately 1100 and 1800 liver transplantations, respectively, are performed every year for hepatocellular carcinoma (HCC), compared with an annual incidence of 65,000 and 39,000 new cases, respectively. Because of organ shortages, proper patient selection is crucial, especially for those exceeding the Milan criteria. Downstaging is the reduction of the HCC burden to meet the eligibility criteria for liver transplantation. Many techniques can be used in downstaging, including ablation, chemoembolisation, radioembolisation and systemic treatments, with a reported success rate of 60–70%. In recent years, an increasing number of patient responders to downstaging procedures has been included in the waitlist, generally with a comparable five-year post-transplant survival but with a higher probability of dropout than HCC patients within the Milan criteria. While the Milan criteria are generally accepted as the endpoint of downstaging, the upper limits of tumour burden for downstaging HCC for liver transplantation are controversial. Very challenging situations involve HCC patients with large nodules, macrovascular invasion or even extrahepatic metastasis at baseline who respond to increasingly more effective downstaging procedures and who aspire to be placed on the waitlist for transplantation. This narrative review analyses the most important evidence available on cohorts subjected to “extended” downstaging, including HCC patients over the up-to-seven criteria and over the University of California San Francisco downstaging criteria. We also address surrogate markers of biological aggressiveness, such as alpha-fetoprotein and the response stability to locoregional treatments, which are very useful in selecting responders to downstaging procedures for waitlisting inclusion.

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“…We previously reported that combined treatment with sorafenib, camrelizumab, TACE, and stereotactic body radiation therapy (SBRT) downstaged advanced HCC with PVTT [ 7 ]. A mean progression-free survival (PFS) of 15.7 months was reported, with an overall response rate reaching 41.7%.…”

Section: Introductionmentioning

confidence: 99%

A Combination of Sorafenib, an Immune Checkpoint Inhibitor, TACE and Stereotactic Body Radiation Therapy versus Sorafenib and TACE in Advanced Hepatocellular Carcinoma Accompanied by Portal Vein Tumor Thrombus

Zhang

Liao

et al. 2022

Cancers

Self Cite

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Background: This study compared the effectiveness of the combined administration of sorafenib, an immune checkpoint inhibitor, transcatheter arterial chemoembolization (TACE), and stereotactic body radiation therapy (SBRT) (SITS group) vs. sorafenib combined with TACE (ST group) in treating and downstaging advanced hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT). Methods: The present study included patients with advanced HCC and PVTT treated with one of the above combination therapies. The downstaging rate, objective response rate (ORR), progression-free survival (PFS), overall survival (OS), disease control rate (DCR), and adverse events (AEs) were assessed. Results: Sixty-two patients were analyzed. The ORR was elevated in the SITS group compared with the ST group (p = 0.036), but no differences were found in DCR (p = 0.067). The survival analysis revealed higher PFS (p = 0.015) and OS (p = 0.013) in the SITS group, with median PFS and OS times of 10.4 and 13.8 months, respectively. Ten patients displayed successful downstaging and underwent surgery in the SITS group, vs. none in the ST group. The prognosis was better in surgically treated patients compared with the non-surgery subgroup, based on PFS (p < 0.001) and OS (p = 0.003). Despite a markedly higher rate of AEs in the SITS group (p = 0.020), including two severe AEs, the SITS combination therapy had an acceptable safety profile. Conclusion: The SITS combination therapy yields higher PFS and OS than the combined administration of sorafenib and TACE in patients with advanced HCC and PVTT, especially as a downstaging strategy before surgery.

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Combination of Sorafenib, Camrelizumab, Transcatheter Arterial Chemoembolization, and Stereotactic Body Radiation Therapy as a Novel Downstaging Strategy in Advanced Hepatocellular Carcinoma With Portal Vein Tumor Thrombus: A Case Series Study

Cited by 20 publications

References 28 publications

Efficacy and safety of camrelizumab plus transarterial chemoembolization in intermediate to advanced hepatocellular carcinoma patients: A prospective, multi-center, real-world study

Efficacy and safety of camrelizumab plus transarterial chemoembolization in intermediate to advanced hepatocellular carcinoma patients: A prospective, multi-center, real-world study

Upper Limits of Downstaging for Hepatocellular Carcinoma in Liver Transplantation

A Combination of Sorafenib, an Immune Checkpoint Inhibitor, TACE and Stereotactic Body Radiation Therapy versus Sorafenib and TACE in Advanced Hepatocellular Carcinoma Accompanied by Portal Vein Tumor Thrombus

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