Combination therapy of sorafenib and drug-eluting bead transarterial chemoembolization for advanced hepatocellular carcinoma with and without hepatic arteriovenous shunt

Abstract

Background: To compare the efficacy and safety of combination therapy with sorafenib and drug-eluting bead transarterial chemoembolization (DEB-TACE) in advanced hepatocellular carcinoma (HCC) with or without hepatic arteriovenous shunt (HAVS). Methods: This retrospective, single-center study enrolled 59 advanced HCC patients treated with combination therapy, of whom 33 (55.9%) patients had HAVS. Tumor response according to the mRECIST criteria was evaluated based on the CT images 1 month after TACE, and changes in the arterial enhancement ratio (AER) of tumors and portal vein tumor thrombosis were also documented. Time-to-progression (TTP), overall survival (OS), and prognostic factors were analyzed. Safety was evaluated with the incidence of TACE-related complications within 6 weeks after TACE. Results: The tumor response between the two groups showed no significant difference in the objective response rate (69.2% in the group without HAVS vs 60.6% in the group with HAVS, p = 0.492) or disease control rate (92.3% vs 87.9%, p = 0.685). The two groups showed comparable TTP (4.23 vs 2.33 months, p = 0.235) and OS (12.77 vs 12.97 months, p = 0.910). A drop in the AER of tumors of more than 20% on post-TACE CT independently predicted better OS. With regard to safety, there was no significant difference between the two groups. Conclusion: For advanced HCC, combination therapy had equal efficacy and safety in patients with HAVS compared to those without HAVS, indicating that DEB-TACE is an optional and effective treatment in these patients.

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

“…For instance, TACE plus sorafenib achieves a median OS of 1.55 years with a 5-year OS rate of 10.7% in HCC patients ( 26 ). TACE plus sorafenib shows an OS of 12.77 months in advanced HCC patients ( 27 ). Another retrospective study disclosed that treatment with pembrolizumab plus TACE and lenvatinib achieved an ORR of 47.1%, a DCR of 70.0%, a median PFS of 9.2 months and an OS of 18.1 months ( 28 ).…”

Hepatic Arterial Infusion Chemotherapy Combined with Lenvatinib and PD-1 Inhibitors for Managing Arterioportal Shunt in Hepatocellular Carcinoma with Portal Vein Tumor Thrombus: A Retrospective Cohort Study

“…Some researchers explored TACE combination with Tyrosine kinase inhibitors for patients with advanced HCC with APS. 31 , 32 However, the severity and/or improvement of APS were not mentioned.…”

Treatment Benefits and Side Effects of Transarterial Chemoembolization with Drug-Eluting Bead Microspheres (DEB-TACE) in Hepatocellular Carcinoma Patients with Conventional TACE Resistance: A Retrospective Study

“…Sorafenib therapy has led to breakthroughs in the treatment of advanced HCC (21). Studies have shown that sorafenib, combined with TACE, can be advantageous for patients with advanced HCC (22). However, sorafenib therapy is not a popular method due to its adverse effects, low tolerance, high price, and low effectiveness.…”