Safety and Efficacy of Transarterial Chemoembolization Combined with Tyrosine Kinase Inhibitor and Immune Checkpoint Inhibitors for Unresectable Hepatocellular Carcinoma: A Single Center Experience

Abstract

Purpose In China, many patients with hepatocellular carcinoma (HCC) are diagnosed at an advanced stage. Several studies have shown that triple therapy [transarterial chemoembolization (TACE) combined with tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs)] is beneficial for patient survival. In this study, we aimed to evaluate the efficacy of triple therapy (TACE + TKIs + ICIs) for unresectable HCC (uHCC) and the conversion rate of surgical resection (SR). The primary endpoints were objective response rate (ORR) and disease control rate (DCR) based on the modified Response Evaluation Criteria in Solid Tumors (mRECIST) and RECIST v1.1 and adverse events (AEs), while the secondary endpoint was the conversion rate of patients with uHCC treated with triple therapy followed by SR. Patients and Methods Forty-nine patients with uHCC who received triple therapy at Fujian Provincial Hospital between January 2020 and June 2022 were retrospectively included. The treatment efficacy, SR conversion rate, and associated AEs were recorded. Results Among the 49 patients enrolled, the ORRs assessed by mRECIST and RECIST v1.1 were 57.1% (24/42) and 14.3% (6/42), respectively, and the DCRs were 92.9% (39/42) and 88.1% (37/42), respectively. Seventeen (34.7%) patients met the criteria for resectable HCC and underwent resection. The median interval between the start of triple therapy and resection was 113.5 days (range 94.75 to 182 d), and the median number of TACE was 2 (range 1 to 2.5). The patients did not achieve median overall survival or median progression-free survival. Treatment-related AEs occurred in 48 (98%) patients, and 18 (36.7%) patients had grade ≥3 AEs. Conclusion Triple combination therapy resulted in a relatively high ORR and conversion resection rate following uHCC treatment.

TACE combined Lenvatinib plus Camrelizumab versus TACE alone in efficacy and safety for unresectable hepatocellular carcinoma: a propensity score-matching study

“…In recent years, conversion therapy has garnered interest in the management of uHCC. Some studies have shown that the 5 years OS rate of surgical resection of converted HCC is not significantly different from that of patients with initially resectable HCC [ 31 ].At present, the surgical convertion rate of different triple therapies ranges from 25.7 − 50% [ 24 – 26 , 28 , 29 , 32 ].The results of this study showed that the surgical conversion rate was 44.3%, which was consistent with the above studies. Among them, 41.9% (18 / 43) of successfully transformed patients achieved complete pathological remission.…”

Portal Venous and Hepatic Arterial Coefficients Predict Post-Hepatectomy Overall and Recurrence-Free Survival in Patients with Hepatocellular Carcinoma: A Retrospective Study

“…The following data at admission were retrospectively analyzed in the present study: sex; age, which was stratified into ≤ 65 or > 65 years old; 15 , 16 albumin and total bilirubin (ALBI) score, which is a well-established model for assessing liver function in patients with HCC and is calculated using the following formula: ; 17 hepatitis B and/or C viral infection by detecting serum surface antigen of hepatitis B virus and detecting serum antibodies against hepatitis C virus; 18 liver cirrhosis, diagnosed by ultrasonography, triphasic liver CT, and/or MRI as described; 19 a serum α fetoprotein level of < 400 ng/mL or ≥ 400 ng/mL; 20 and Barcelona Clinic Liver Cancer (BCLC) stage. 14 …”

Case report: Complete response after transcatheter arterial chemoembolization combined with donafenib plus tislelizumab therapy for hepatocellular carcinoma with main trunk portal vein tumor thrombus in a patient coinfected with HIV and HBV

“…The efficacy of pembrolizumab plus lenvatinib for the treatment of uHCC did not meet the preset endpoint but prolonged the median OS and PFS to 21.2 and 8.2 months, respectively, when compared to treatment with lenvatinib plus placebo in the global LEAP-002 study ( 17 ). Moreover, several real-world studies showed that combination therapy could enhance the efficacy, in which the combination of TACE and systemic therapy has shown promising results, especially TACE combined with tyrosine kinase inhibitors (TKIs) and PD-1 inhibitors can significantly increase ORR, OS, and PFS ( 18 – 20 ). Moreover, Zou et al.…”