Transarterial chemoembolization plus lenvatinib with or without programmed death-1 inhibitors for patients with unresectable hepatocellular carcinoma: A propensity score matching study

Abstract

PurposeWe conducted a retrospective study to compare transarterial chemoembolization (TACE) plus lenvatinib plus programmed death-1 (PD-1) inhibitors with TACE plus lenvatinib in patients with unresectable hepatocellular carcinoma (HCC).Patients and methodsPatients with HCC were analyzed from January 2018 to January 2022 in three hospitals. Patients received TACE plus lenvatinib with or without PD-1 inhibitors (TACE+L+PD-1 or TACE+L, respectively). The baseline characteristics of the two groups were compared, and propensity score matching (PSM) was performed. Overall survival (OS), progression-free survival (PFS), and objective response rate (ORR) of the two groups were compared. Adverse events in the two groups were analyzed.ResultsA total of 166 patients were evaluated (TACE+L+PD-1, n = 75; TACE+L, n = 91). Before PSM, OS was prolonged in the TACE+L+PD-1 group (p = 0.010), but PFS was similar between the two groups (p = 0.18). ORR was higher in the TACE+L+PD-1 group (p = 0.047). After PSM, estimated OS rates at 6, 12, and 24 months were 97.9%, 84.6%, and 74.1%, respectively, in the TACE+L+PD-1 group (n = 48) and 93.1%, 66.1%, and 43.4%, respectively, in the TACE+L group (n = 48). Estimated PFS rates at 3, 6, and 12 months were 81.9%, 61.8%, and 30.9%, respectively, in the TACE+L group and 95.7%, 82.1%, and 68.4%, respectively, in the TACE+L+PD-1 group. OS, PFS, and ORR were improved in the TACE+L+PD-1 group compared to the TACE+L group (p = 0.030; p = 0.027; p = 0.013). The safety of the TACE+L+PD-1 regimen was acceptable.ConclusionsThe addition of PD-1 inhibitors to TACE+L significantly improved clinical outcomes in patients with unresectable HCC. Side effects were manageable.

The efficacy and safety of lenvatinib plus transarterial chemoembolization in combination with PD-1 antibody in treatment of unresectable recurrent hepatocellular carcinoma: a case series report

“…No grade 4 AE occurred in these patients, which may be explained by the dosage reduction of lenvatinib once grade 3 AE occurs. These data are similar to those of the previous studies in primary HCC ( 11 , 18 ), and we concluded that the LEN-TAP regimen is safe and tolerable in urHCC patients.…”

“…According to our data, only one patient achieved conversion resection after 4 months of LEN-TAP treatment, which was significantly lower than the data in primary advanced-stage HCC according to previous reports ( 18 ). This may be partially because of the biological features of recurrent hepatocellular carcinoma and its special tumor microenvironment ( 16 ).…”

Prognoses of Patients Treated With Surgical Therapy Versus Continuation of Local-Plus-Systemic Therapy Following Successful Down-Staging of Intermediate-Advanced Hepatocellular Carcinoma: A Multicenter Real-World Study

“…The surgical and nonsurgical groups had median OS of 38.3 months and 23.2 months, respectively, and the median OS of the non-surgical patients was consistent with that described previously. 22 , 23 The 1, 2, 3, and 4-years OS rates of surgical and nonsurgical groups were 98.0%, 88.0%, 83.0%, 62%, and 78.0%, 51.0%, 41.0%, 41.0%, respectively ( P < .001). Therefore, for intermediate-advanced HCC patients who received local-plus-systemic therapy initially and successful down-staging to meet the criteria for surgical resection, surgical therapy could improve patient’s OS.…”

Lenvatinib, sintilimab plus transarterial chemoembolization for advanced stage hepatocellular carcinoma: A phase II study

“…8,[12][13][14][15][16] Inspiringly, recent trials have proven striking efficacy of lenvatinib plus PD-1 inhibitors in patients with unresectable HCC. 8,15,16 Although there was insufficient evidence that the addition of PD-1 inhibitor to lenvatinib was superior to lenvatinib monotherapy, some retrospective studies, 6,[34][35][36][37][38] including ours, have shown that Len-TACE in combination with PD-1 inhibitor conferred improved response rate and survivals over Len-TACE for advanced HCC. In the present study, with the triple treatment of Len-Sin-TACE, remarkable clinical benefits in ORR, PFS and OS were achieved despite the extensive tumour burden on the patients.…”