TACE-HAIC combined with targeted therapy and immunotherapy versus TACE alone for hepatocellular carcinoma with portal vein tumour thrombus: a propensity score matching study

Abstract

Background: The long-term survival of patients with hepatocellular carcinoma (HCC) with portal vein tumour thrombus (PVTT) is poor. Systemic therapy, transcatheter arterial chemoembolization (TACE), and hepatic artery infusion chemotherapy are widely used in HCC patients with PVTT. This study aims to explore the efficacy of combining systemic therapy with transarterial-based therapy in HCC patients with PVTT. Materials and methods: The authors retrospectively reviewed data of HCC patients with PVTT treated with combination therapy (TACE-hepatic artery infusion chemotherapy with tyrosine kinase inhibitors and PD-1 inhibitors) or TACE alone in SYSUCC from 2011 to 2020. The overall survival (OS), progression-free survival, and overall response rate were compared. Propensity score matching was used to minimize confounding bias. Results: A total of 743 HCC patients with PVTT received combination therapy (n=139) or TACE alone (n=604). After propensity score matching, the overall response rate was significantly higher in the combination group than in the TACE group [42.1% vs. 5.0%, P < 0.001 (response evaluation criteria in solid tumours); 53.7% vs. 7.8%, P < 0.001 (modified response evaluation criteria in solid tumours)]. The combination group showed significantly better OS than the TACE group (median OS not reached vs. 10.4 months, P < 0.001). The median progression-free survival of the combination and TACE groups was 14.8 and 2.3 months (P < 0.001), respectively. Tumour downstaging followed by salvage liver resection was significantly more common for the combination therapy group than for TACE group (46.3% vs. 4.5%, P < 0.001). After salvage liver resection, 31.6% (30/95) and 1.7% (3/179) of the patients achieved a pathological complete response in the combination and TACE groups, respectively (P < 0.001). The grade 3/4 adverse events rates were similar between the two groups (28.1% vs. 35.9%, P=0.092). Conclusion: Compared with TACE alone, combination therapy was safe enough and resulted in survival benefits. This is a promising treatment option for HCC patients with PVTT.

Transcatheter Arterial Chemoembolization Combined with Hepatic Arterial Infusion Chemotherapy Versus Transcatheter Arterial Chemoembolization for Unresectable Hepatocellular Carcinoma: A Systematic Review and Meta-analysis

“… 45 Liu et al 46 combined sorafenib with TACE–HAIC, resulting in 6-month, 12-month, and 24-month PFS rates of 75.0%, 54.7%, and 30.0%, respectively, demonstrating significant efficacy and good tolerability in unresectable HCC patients. Yuan et al 47 combined TKIs with PD-1 inhibitors in patients with HCC and PVTT who underwent TACE–HAIC, and the results showed improved survival outcomes, pathological CR rates, and conversion rates compared to TACE monotherapy. Drawing on the same rationale, a meta-analysis 48 has assessed the effectiveness of the combined therapeutic approach involving HAIC in conjunction with sorafenib.…”

Transarterial chemoembolization with molecular targeted therapies plus camrelizumab for recurrent hepatocellular carcinoma

“…We used three molecular targeted drugs because they have similar targets inspired by the new clinical research strategy perspective of Menis et al [ 44 ]. This design can validate a treatment strategy involving a mixture of agents and has been successfully conducted in several trials [ 45 , 46 ].…”

Efficacy and safety of targeted therapy plus immunotherapy combined with hepatic artery infusion chemotherapy (FOLFOX) for unresectable hepatocarcinoma

“…At the same time, the chemotherapeutic drugs circulate in the bloodstream throughout the entire body, playing a role in systemic chemotherapy. Compared with systemic chemotherapy, HAIC improves the local drug perfusion concentration and reduces the systemic toxic and side effects of chemotherapeutics, opening up a wide range of valuable clinical applications[ 17 ].…”