Apatinib Plus Camrelizumab With/Without Chemoembolization for Hepatocellular Carcinoma: A Real-World Experience of a Single Center

Abstract

ObjectiveThis study was conducted in order to compare the efficacy and safety of transarterial chemoembolization (TACE) plus apatinib plus camrelizumab (TACE+AC) and apatinib plus camrelizumab (AC) in the treatment of unresectable hepatocellular carcinoma (HCC) in a real-world setting.MethodsIn this single-center retrospective study, the data of patients with unresectable HCC who had received TACE+AC or AC treatment during March 2017 to May 2021 were assessed. Patients in the AC group received intravenous administration of camrelizumab 200 mg every 3 weeks and oral apatinib 250 mg/day treatment. Patients in the TACE+AC group received the same dose of camrelizumab and apatinib 1 week after TACE. The primary endpoint of the study was overall survival (OS), objective response rate (ORR), disease control rate (DCR), and adverse events (AEs) as the secondary endpoints.ResultsA total of 108 patients were enrolled in the study. There were 52 patients in the AC group and 56 patients in TACE+AC group. Median OS was significantly longer in the TACE+AC group than in the AC group (24.8 vs. 13.1 months; P = 0.005). Patients in the TACE+AC group achieved a higher ORR [24 (42.9%) vs. 9 (17.3%), P = 0.004] than those in the AC group. Patients in the TACE+AC group also achieved a higher disease control rate (DCR) [48 (85.7%) vs. 30 (57.7%), P = 0.001] than patients in the AC group. There was no significant difference in the incidence of AEs related to apatinib and camrelizumab between the two groups, except for gastrointestinal reaction (P > 0.05, all; P < 0.05, gastrointestinal reaction).ConclusionTACE plus apatinib plus camrelizumab significantly improved OS, ORR, and DCR over apatinib plus camrelizumab in patients with unresectable HCC. AEs were tolerable and manageable.

The Significance of Transarterial Chemo(Embolization) Combined With Tyrosine Kinase Inhibitors and Immune Checkpoint Inhibitors for Unresectable Hepatocellular Carcinoma in the Era of Systemic Therapy: A Systematic Review

“…Ju et al. ( 39 ) found that TACE+apatinib+camrelizumab provided a clinical benefit for the subgroups of age <65 years old, men, PS score of 1, Child–Pugh classification of B, liver cirrhosis, hepatitis B infection, and AFP >200 mg/ml (all P<0.05), and similar findings were observed in the study of Zheng et al. ( 33 ).…”

“…PFS at 0.5, 1, 1.5, and 2 years were evaluated in 13 ( 21 , 25 , 31 – 38 , 40 – 42 ), 13 ( 21 , 25 , 31 – 38 , 40 – 42 ), 11 ( 21 , 25 , 31 – 37 , 41 , 42 ), and 5 studies ( 21 , 32 , 34 , 37 , 42 ), and the pooled rates and 95%CI were 0.781 (0.688-0.862), 0.387 (0.293-0.486), 0.117 (0.076-0.165), and 0.069 (0.005-0.182), respectively ( Table 3 ). OS at 0.5, 1, 1.5, 2, and 3 years were evaluated in 12 ( 21 , 25 , 31 – 36 , 39 – 42 ), 12 ( 21 , 31 – 34 , 39 – 42 ), 12 ( 21 , 31 – 34 , 39 – 42 ), 9 ( 21 , 31 – 34 , 39 – 42 ), and 5 studies ( 21 , 31 – 33 , 42 ), and the pooled rates and 95%CI were 0.943 (0.902-0.975), 0.690 (0.585-0.786), 0.385 (0.246-0.533), 0.212 (0.117-0.324), and 0.056 (0.028-0.091), respectively ( Table 3 ).…”

“…There were 7 studies incorporating the control group ( 21 , 25 , 33 – 35 , 39 , 40 ), and the control group was TACE+TKIs in three studies ( 21 , 33 , 40 ), TKIs+ICIs in three ( 34 , 35 , 39 ), and TKIs in one ( 25 ), respectively. Results showed that TACE/HAIC+TKIs+ICIs was superior to TKIs alone in all fields ( Table 5 ), and similar advantage were also observed compared to TACE+TKIs and TKIs+ICIs (all P<0.05, Table 5 ).…”

Efficacy and Safety of Apatinib in Advanced Hepatocellular Carcinoma: A Multicenter Real World Retrospective Study

“…The overall mPFS and mOS were significantly longer than those found in other retrospective studies involving apatinib (mPFS: 7.0 vs. 5.0 months; mOS: 16.0 vs. 13.0 months), especially as a second-line treatment; this may be due to the combination with immunotherapy (mOS: 14.0 months; mPFS: 8.0 months) or TACE (mOS: 20.0 months; mPFS: 11.0 months) in some patients in this study ( Zhen et al, 2018 ; Qin et al, 2021 ). In a recent single-center retrospective study about unresectable HCC, apatinib plus camrelizumab demonstrated the mOS of 13.1 months, which was similar to our results (14.0 months) ( Ju et al, 2021 ). Similar to other studies, apatinib combined with TACE significantly improved mPFS and mOS.…”

Four-Pyroptosis Gene-Based Nomogram as a Novel Strategy for Predicting the Effect of Immunotherapy in Hepatocellular Carcinoma

“…Jiang et al have found that metformin triggers the NF-κB signal pathway, which leads to caspase-3/GSDME-mediated cancer cell death [48]. Many recent attempts to increase effectiveness by combining TACE and targeted treatment with immunotherapy have been documented [49][50][51][52]. As a local chemotherapy modality, TACE can promote better immunotherapy by modulating the TIME [50].…”