Role and limitation of neoadjuvant hepatic arterial infusion chemotherapy in advanced hepatocelluar carcinoma patients with Child-Pugh class A

Abstract

Background: Patients with advanced hepatocellular carcinoma (HCC) have a poor oncologic outcome. In this study, we evaluated the role and limitation of neoadjuvant hepatic arterial infusion chemotherapy (HAIC) in advanced HCC patients with Child-Pugh class A and the efficacy of liver resection subsequent to downstaging after neoadjuvant HAIC. Methods: In the present retrospective study, 103 patients with advanced HCC, who underwent neoadjuvant HAIC from April 2003 to March 2015 were analyzed. Response to HAIC was evaluated by dividing time period into after 3 cycles and after 6 cycles, each defined as early and late period. Liver resection after neoadjuvant HAIC was offered in patients who were considered as possible candidates for curative resection with tumor-free margin as well as sufficient future liver remnant volume. Results: The median survival time (MST) in all patients was 14 ± 1.7 months. Response rate and disease control rate were 36.3% (37) and 81.4% (83) in early period, respectively, and 26.4% (14) and 47.2% (25), in late period, respectively (P = 0.028). Twelve patients (11.7%) underwent liver resection after neoadjuvant HAIC and the MST was 37 ± 6.6 months. One-, 3-, and 5-year recurrence-free survival after liver resection were 58.3%, 36.5%, and 24.3% respectively. Liver resection was identified as the only independent prognostic factor that associated with overall survival in multivariate analysis (P = 0.002) Conclusion: HAIC could be further alternative for the treatment of advanced HCC in patients with good liver function. If liver resection is possible after neoadjuvant HAIC, liver resection would provide better outcomes than HAIC alone.

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

“…A research confirmed that the survival data of downstaged HCC, followed by a salvage surgery, were similar to those of initially resectable HCC (22). Downstaging therapies reported in the literature include transarterial chemoembolization, transarterial radioembolization, radiotherapy, hepatic arterial infusion (25). A case report demonstrated a superior treatment effect and fewer adverse events of lenvatinib in combination with nivolumab, followed by extended right hepatectomy (11).…”

“…Lee et al. applied hepatic arterial infusion chemotherapy as a downstaging strategy in patients with advanced HCC, and 12 of 103 (11.7%) patients were downstaged to surgery ( 25 ). A case report demonstrated a superior treatment effect and fewer adverse events of lenvatinib in combination with nivolumab, followed by extended right hepatectomy ( 11 ).…”

<p>Knockdown of FOXO6 Inhibits Glycolysis and Reduces Cell Resistance to Paclitaxel in HCC Cells via PI3K/Akt Signaling Pathway</p>

“…Recent years have witnessed the increase in the incidence of HCC with the change of social environment. 13 Currently, chemotherapy resistance remained the main factor leading to poor therapeutic efficacy and poor prognosis in HCC patients, so it is of great clinical significance to explore the drug resistance mechanism of HCC cells. 14 In our study, FOXO6 was first demonstrated to be associated with glycolysis and paclitaxel resistance in HCC cells, whose mechanism may be achieved by affecting the PI3K/Akt signaling pathway.…”

Adjuvant versus Neoadjuvant Immunotherapy for Hepatocellular Carcinoma: Clinical and Immunologic Perspectives

“…Only five studies reported the treatment response and resection rate after downstaging neoadjuvant therapy and all of them were retrospective studies (►Supplementary Table S2). [58][59][60][61][62] The reported ORR, according to the Response Evaluation Criteria in Solid Tumors (RECIST) or modified RECIST assessment for HCC, ranged from 16.5 to 28.4% and the successful resection rate after downstaging was 11.7 to 26.5%. The safety profile was reported in three studies and abnormal liver function tests were the most common adverse events (AEs).…”