Idarubicin‐Loaded DEB‐TACE plus Lenvatinib versus Lenvatinib for patients with advanced hepatocellular carcinoma: A propensity score‐matching analysis

Abstract

Aims To investigate the efficacy and safety of lenvatinib and idarubicin‐loaded drug‐eluting beads transarterial chemoembolization (IDADEB‐TACE) in primary advanced hepatocellular carcinoma (HCC). Methods This retrospective study included patients with primary advanced HCC who received either lenvatinib monotherapy or lenvatinib plus IDADEB‐TACE as first‐line treatment from September 2019 to September 2020 at three institutes. Overall survival (OS), time to progression (TTP), objective response rate (ORR), and adverse events were compared. Propensity score‐matching was used to reduce the influence of confounding factors on the outcomes. Results The study reviewed 118 patients who received lenvatinib plus IDADEB‐TACE (LIDA group) and 182 who received lenvatinib alone (LEN group). After propensity score‐matching, 78 pairs of patients remained. Compared to patients in the LEN group, those in the LIDA group had better post‐treatment ORR (57.7% vs. 25.6%, p < 0.001, respectively), median OS and TTP (15.7 vs. 11.3 months, hazard ratio [HR] = 0.50, p < 0.001; 8.0 vs. 5.0 months, HR = 0.60, p = 0.003, respectively), 6‐ and 12‐month OS rates (88.5% vs. 71.4%; 67.6% vs. 43.4%, respectively), and progression‐free rates at 6 and 12 months (60.3% vs. 42.3%; 21.1% vs. 10.3%, respectively). Vascular invasion, α‐fetoprotein level, and treatment type were independent OS predictors, and vascular invasion and treatment type were independent TTP predictors. Incidences of nausea/vomiting, fever, abdominal pain, and increased ALT/AST were higher in the LIDA group than in the LEN group. Conclusions Lenvatinib plus IDADEB‐TACE is well‐tolerated and more effective than lenvatinib monotherapy in patients with advanced HCC.

S3-Leitlinie „Diagnostik und Therapie des Hepatozellulären Karzinoms“ – Langversion 4.0

“…In retrospektiven Studien bei Patienten (vorweigend aus dem asiatischen Raum und HBV) mit fortgeschrittenem Stadium BCLC B und bei Patienten mit Stadium BCLC C (mit Pfortaderinvasion und/oder extrahepatischer Metastasierung) bei denen eine Indikation zur TACE gestellt wird, konnte das progressionsfreies Überleben und Gesamtüberleben verlängert werden, wenn die TACE mit einer Systemtherapie mit Lenvatinib und PD-1-Inhibitor kombiniert wird [396][397][398][399][400].…”

Efficacy and safety of transarterial chemoembolization plus lenvatinib in the treatment of advanced hepatocellular carcinoma: A meta-analysis

“…A total of 573 articles were retrieved, and 244 repeated articles were excluded by title, year of publication, and author information. Then after reading abstracts and full-text screening, 311 articles that did not meet the criteria were excluded and finally included 18 studies [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] (Fig. 1).…”

“…Ten studies [9][10][11][12][13][14][15][16]18,25] provided 6-month OS rate data, of which 5 studies [9,11,14,18,25] were TACE plus lenvatinib versus TACE alone, and the other 5 studies [10,12,13,15,16] were TACE plus lenvatinib versus lenvatinib alone. Based on the heterogeneity test results (P = .95, I 2 = 0%; P = .52, I 2 = 0%).…”

“…See Figure 5A. The ten and 9 included studies reported that 12-month [9][10][11][12][13][14][15][16]18,25] and 18-month [9][10][11][12][13][14][15][16]18] OS rates, respectively. The results of the heterogeneity test showed that the heterogeneity among the studies was small (P > .1, I 2 < 50%).…”

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

“…4,20 Previous studies have evaluated lenvatinib plus TACE (Len-TACE) in patients with advanced/unresectable HCC and showed superior treatment efficacy of the combination versus lenvatinib or TACE alone. 7,[22][23][24] More recently, we conducted a retrospective study and found that the combination of lenvatinib, PD-1 inhibitor and TACE conferred improved tumour control and survival benefit in patients with advanced stage HCC, implying that the triple therapy might bring a synergistic antitumour effect for HCC. 6 Herein, we present the results of a single-arm phase II study which explored the efficacy and safety of lenvatinib, sintilimab (a PD-1 inhibitor) plus TACE (Len-Sin-TACE) as the first-line treatment for advanced stage HCC.…”