Comparable Clinical Outcomes Between Transarterial Chemoembolization or Hepatic Arterial Infusion Chemotherapy Combined with Tyrosine Kinase Inhibitors and PD-1 Inhibitors in Unresectable Hepatocellular Carcinoma

Abstract

Purpose To compare the treatment efficacy and safety of transarterial chemoembolization (TACE) or hepatic arterial infusion chemotherapy (HAIC) combined with tyrosine kinase inhibitors (TKIs) and programmed cell death protein-1 (PD-1) inhibitors for patients with unresectable hepatocellular carcinoma (HCC). Patients and Methods 81 unresectable HCC patients were retrospectively analyzed, including 30 or 51 patients treated with either TKIs and PD-1 inhibitors combined with TACE (TTP) or HAIC (HTP), respectively. Tumor response and survival outcomes were compared. Results The median overall survival (mOS) was 21.0 months in the TTP group and 15.0 months in the HTP group (P = 0.525; HR = 1.23; 95% CI 0.66–2.29). The median progression-free survival (mPFS) was 6.7 months in the TTP group and 9.9 months in the HTP group (P = 0.160; HR = 0.70; 95% CI 0.42–1.16). After Propensity Score Matching (PSM), the mOS was 21.0 months in the TTP group and 18.0 months in the HTP group (P = 0.644; HR = 1.20; 95% CI 0.56–2.58). The mPFS was 6.4 months in the TTP group and 15.0 months in the HTP group (P = 0.028; HR = 0.49; 95% CI 0.26–0.93). The disease control rate in overall response (90.2% vs 76.7%, P = 0.116, before PSM; 91.7% vs 75.0%, P = 0.121, after PSM) and intrahepatic response (94.1% vs 80.0%, P = 0.070, before PSM; 91.7% vs 79.2%, P = 0.220, after PSM) were higher in the HTP group than in the TTP group. Conclusion Though including more advanced tumors, the clinical outcomes of HAIC combined with TKIs and PD-1 inhibitors are comparable to TACE-based combination therapy for unresectable HCC. Nevertheless, HTP significantly improved the PFS benefits in HCC patients with with large tumor burden or vascular invasion.

Efficacy and Safety of Conversion Surgery for Advanced Hepatocellular Carcinoma After Hepatic Arterial Infusion Chemotherapy

“…9,26 However, reassuringly, the ease of operation, safety, and survival benefit of HAIC in the treatment of HCC have been initially demonstrated. The results of studies showed that HAIC provided a relatively high response rate and acceptable toxicity in the treatment of HCC, which to a certain extent reflected the safety and efficacy of HAIC in the treatment of liver cancer; [12][13][14][15][16][17][18]21,22,27 in addition, HAIC still provided substantial benefit in some patients, eg, in patients with portal vein thrombosis or high intrahepatic tumor burden. 18,31 When combined with PD-1 inhibitors or TKIs, HAIC could also improve the prognosis of patients.…”

“…[12][13][14][15] Besides, HAIC combined with tyrosine kinase inhibitors (TKIs) and programmed cell death protein-1 (PD-1) inhibitors also could prolong the overall survival (OS) and progression-free survival (PFS) in HCC patients with large tumor burden or vascular invasion. 16,17 Other studies also showed that for HCC whose tumor burden was mainly concentrated in the liver or combined with portal vein tumor thrombosis, FOLFOX-HAIC was more effective than drug-targeted therapy with a higher tumor remission rate. 18 Patients after HAIC treatment may substantially reduce tumor burden or considerable shrinkage of tumor thrombi in large blood vessel staining and, thereby, obtain the opportunity for conversion resection or ablation radical cure, which can improve the prognosis.…”