Combined Stereotactic Body Radiotherapy and Immunotherapy Versus Transarterial Chemoembolization in Locally Advanced Hepatocellular Carcinoma: A Propensity Score Matching Analysis

Abstract

Immunotherapy has achieved modest clinical activity in HCC patients. Propensity score matching analysis was conducted to compare the efficacy and safety of combined stereotactic SBRT-IO versus TACE in patients with locally advanced HCC in a tertiary center of Hong Kong. Patients with locally advanced HCC who were medically inoperable for, refractory to, or refused to curative surgical interventions were eligible. The primary outcome was PFS; the secondary outcomes were OS, ORR as per mRECIST version 1.1, and TRAEs. Matching pair analysis was performed to compare the clinical outcomes. A total of 226 patients were eligible. Approximately 16 patients in the SBRT-IO group were matched with 48 patients treated with TACE. The median tumor size was 10 cm (range: 2.9–19.6 cm) and 20.3% of the patients had portal vein invasion. The 12- and 24-month PFS were significantly better in the SBRT-IO group (93.3% vs 16.7% and 77.8% vs 2.1%, respectively, p <0.001); the 12- and 24-month OS were also better in the SBRT-IO arm (93.8% vs 31.3% and 80.4% vs 8.3%, respectively, p <0.001). The ORR was 87.5% (CR: 50%, PR: 37.5%) in SBRT-IO arm compared to 16.7% (CR: 2.4%, PR: 14.3%) in those receiving TACE alone (p <0.001). There were fewer ≥grade 3 TRAE (60.4% vs 18.8%, p = 0.004) and treatment discontinuations (25% vs 12.5%, p = 0.295) due to adverse events in the SBRT-IO arm. SBRT-IO had significant superior survival and less treatment toxicity than TACE in patients with locally advanced HCC. Our results provide rationale for studying this combination therapy in prospective randomized trials.

Prognostic Value of a CT Radiomics-Based Nomogram for the Overall Survival of Patients with Nonmetastatic BCLC Stage C Hepatocellular Carcinoma after Stereotactic Body Radiotherapy

“…It is important to investigate the individual basis of prognostic factors and treatment options for these groups. More and more published studies have demonstrated the beneft of integrating SBRT with other treatment modalities [8][9][10]. We established and validated a nomogram to show these patients' 6-, 12-, and 18-month post-SBRT survival probabilities.…”

“…Another study reported that in HCC patients with regional lymph node or distant metastases, combined SBRT of the intrahepatic HCC lesions demonstrated superior survival OS compared to those treated systemically only [ 9 ]. In addition, the combination of SBRT and immunotherapy achieved favorable control (CR rate: 50%) in patients with BCLC-C HCC, even though only a nonablative dose of radiation was delivered because of the extensive tumor burden [ 10 ]. SBRT sequenced with systemic or TACE was conditionally recommended for patients with BCLC-C HCC by some clinical evidence-based treatment guidelines [ 11 , 12 ].…”

Case Report: Radiotherapy Plus Immunotherapy and Lenvatinib for the Treatment of Recurrent Hepatocellular Carcinoma With a Right Atrium and Inferior Vena Cava Tumor Thrombus

“…Yttrium-90 radioembolization (Y-90 RE) plus immunotherapy was safe and effective in patients with advanced HCC, with an objective response rate of 31% ( 38 ). The combination of radiotherapy and immunotherapy in patients with HCC showed 1- and 2-year PFS of 93.3% and 77.8%, respectively ( 39 ). A phase I trial reported that radiotherapy plus ipilimumab had clinical benefits in 23% of patients with liver/lung cancer ( 40 ).…”

“…Additional radiotherapy did not increase the side effects in our case. A previous study suggested that radiotherapy plus immunotherapy did not cause radiation-induced liver disease and treatment-related deaths ( 39 ).…”

Radiotherapy Enhances Efficacy of PD-1 inhibitors in Advanced Liver Cancer: A Real-world Data

“…Meanwhile, a study by Chiang et al described higher ORR in ve patients with unresectable, large HCC, treated with RT plus ICIs 17 . They further investigated 15 patients with advanced HCC who had a better prognosis after treatment with RT-ICIs than that with TACE 32 . In addition, treatment of a case with macroscopic vascular invasive HCC with Y-90 radioembolization plus nivolumab successfully decreased the extent of treatment to partial hepatectomy 33 .…”