Combination of TACE and Lenvatinib as a promising option for downstaging to surgery of initially unresectable intrahepatic cholangiocarcinoma

Yuan, Peng; Song, Jun; Wang, Fei; Zhu, Guangyu; Chen, Baoan

doi:10.1007/s10637-022-01257-z

Cited by 6 publications

(3 citation statements)

References 30 publications

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“…However, the efficacy of TACE monotherapy of unresectable and advanced HCC is unsatisfactory. In contrast, the combination of TACE with lenvatinib has yielded favorable results ( 8 , 19 , 20 ) and is better than TACE monotherapy. In the LAUNCH trial, a phase III and randomized clinical trial, TACE combined with lenvatinib vs. lenvatinib alone as first-line treatment for advanced hepatocellular carcinoma, the median OS and PFS were significantly longer in the TACE+L group than lenvatinib group (17.8 vs. 11.5 months; 10.6 vs. 6.4 months); patients in the TACE+L group had a significantly higher ORR according to the modified RECIST criteria (54.1% vs. 25.0%) ( 21 ).…”

Section: Discussionmentioning

confidence: 99%

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

Guo

Gao

et al. 2022

Front. Oncol.

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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.

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Section: Discussionmentioning

confidence: 99%

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

Guo

Gao

et al. 2022

Front. Oncol.

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“…Surgical resection is currently the first-line treatment for resectable ICC [ 13 ]. Systemic therapy, radiation, and various liver-directed therapies are considered in select cases for patients who are high-risk surgical candidates or initially unresectable [ 25 , 33 , 34 , 35 ]. Available data on the use of NAT for ICC are limited and often extrapolated from studies utilizing NAT to downstage patients for surgical resection.…”

Section: Discussionmentioning

confidence: 99%

Systemic Therapy Is Associated with Improved Oncologic Outcomes in Resectable Stage II/III Intrahepatic Cholangiocarcinoma: An Examination of the National Cancer Database over the Past Decade

Marcus

Christopher

Keller

et al. 2022

Cancers

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Limited evidence-based management guidelines for resectable intrahepatic cholangiocarcinoma (ICC) currently exist. Using a large population-based cancer registry; the utilization rates and outcomes for patients with clinical stages I-III ICC treated with neoadjuvant chemotherapy (NAT) in relation to other treatment strategies were investigated, as were the predictors of treatment regimen utilization. Oncologic outcomes were compared between treatment strategies. Amongst 2736 patients, chemotherapy utilization was low; however, NAT use increased from 4.3% to 7.2% (p = 0.011) over the study period. A higher clinical stage was predictive of the use of NAT, while higher pathologic stage and margin-positive resections were predictive of the use of adjuvant therapy (AT). For patients with more advanced disease, the receipt of NAT or AT was associated with significantly improved survival compared to surgery alone (cStage II, p = 0.040; cStage III, p = 0.003). Furthermore, patients receiving NAT were more likely to undergo margin-negative resections compared to those treated with AT (72.5% vs. 62.6%, p = 0.027), despite having higher-risk tumors. This analysis of treatment strategies for resectable ICC suggests a benefit for systemic therapy. Prospective and randomized studies evaluating the sequencing of treatments for patients with high-risk resectable ICC are needed.

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“…A current prospective randomized phase II study found that the combination of irinotecan-based DEB-TACE (DEBIRI) with cisplatin/gemcitabine-based systemic therapy resulted in significantly prolonged overall survival compared with cisplatin/gemcitabine-based systemic therapy alone (33.7 months vs. 12.6 months, p < 0.04) [ 33 ]. In addition to prolonging overall survival, further retrospective studies have also demonstrated that TACE in CCA can be a safe and efficacious conversion therapy modality that allows for secondary resectability in initially unresectable CCA [ 34 ]. Large randomized controlled trials of the combined use of TACE and immune checkpoint inhibitors have been lacking in CCA.…”

Section: Transarterial (Chemo-)embolization (Tae and Tace)mentioning

confidence: 99%

Update on Locoregional Therapies for Cholangiocellular Carcinoma

Morawitz

Bruckmann

Jannusch

et al. 2023

Cancers

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Locoregional therapy options for CCA are used, in particular, for non-resectable tumors and aim to reduce tumor viability or delay tumor growth and ultimately prolong overall survival. In addition to local ablative procedures such as radiofrequency- or microwave-ablation, transarterial procedures such as transarterial embolization (TAE), transarterial chemoembolization (TACE), or selective internal radiotherapy (SIRT) play a major role. In particular, in combination with advances in molecular medicine and immunotherapy, there has been a further development in the therapy of primary malignant liver tumors in recent years. In this review, we analyze data from recent studies and examine the implications for therapy of CCA, particularly with regard to the combination of locoregional therapies with modern systemic therapies.

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Combination of TACE and Lenvatinib as a promising option for downstaging to surgery of initially unresectable intrahepatic cholangiocarcinoma

Cited by 6 publications

References 30 publications

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

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

Systemic Therapy Is Associated with Improved Oncologic Outcomes in Resectable Stage II/III Intrahepatic Cholangiocarcinoma: An Examination of the National Cancer Database over the Past Decade

Update on Locoregional Therapies for Cholangiocellular Carcinoma

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