Safety and Efficacy of Drug-Eluting Bead Transarterial Chemoembolization Combined with Lenvatinib and Anti-PD-1 Antibodies for Unresectable Hepatocellular Carcinoma: A Retrospective Analysis

Abstract

Background Drug-eluting bead transarterial chemoembolization (DEB-TACE) has good efficacy in the treatment of unresectable hepatocellular carcinoma (uHCC), with a relatively high objective response rate (ORR) compared to conventional transarterial chemoembolization (cTACE). This study aimed to evaluate the safety and medium-term clinical efficacy of DEB-TACE combined with lenvatinib (LEN) plus PD-1 inhibitors as a triple therapy for the treatment of uHCC. Methods Data of patients with uHCC who received triple therapy of DEB-TACE combined with LEN plus PD-1 inhibitors from January 2019 to June 2021 were analyzed retrospectively. The study endpoints were ORR, progression-free survival (PFS), and treatment-related adverse events based on the modified Response Evaluation Criteria in Solid Tumors (mRECIST). Results Thirty-five patients were included in this study, with a median follow-up period of 15 months. The median cycle of DEB-TACE was 1, while that of all forms of TACE procedures per patient was 2. The median administration time of LEN was 7 months, and the median number of PD-1 inhibitor treatment was 4 cycles. The ORR based on mRECIST was 82.9%, disease control rate was 91.4%, and the median time to response was 7 weeks. Among these, the ORR of Barcelona Clinic Liver Cancer (BCLC) stage A reached 100%, while that of BCLC stages B and C reached 84.6% and 78.9%, respectively. The median PFS was 9 months; the mOS was not reached. Fourteen patients (40%) successfully underwent downstaging conversion and surgical resection, 32 patients (91.4%) experienced treatment-related adverse events, and no grade 5-related adverse reactions occurred. Conclusion DEB-TACE combined with LEN and PD-1 inhibitors has a high ORR and surgical conversion rate in the treatment of uHCC tumors, and the toxicity and side effects were tolerable.

Transarterial Chemoembolization Combined with Tyrosine Kinase Inhibitors Plus Immune Checkpoint Inhibitors for Advanced Hepatocellular Carcinoma: A Propensity Score Matching Analysis

“…The differences in the results might be attributed to different baseline characteristics among the studies. For example, the proportions of patients with BCLC stage C (54.3%) and extrahepatic metastasis (8.6%) in Wu et al’s study 29 was significantly lower compared to those observed in our study, and these features were associated with poor prognosis.…”

“… 11 , 32 In addition to camrelizumab and sintilimab, other ICIs such as tislelizumab, pembrolizumab, and toripalimab have also been used in similar studies. 19 , 29 However, the optimal drug regimen for advanced HCC remains uncertain in real-world practice due to the heterogeneity of this tumor, and our study provided new insights into multi-drug combination therapy.…”

“… 28 Cai et al 19 revealed that the median OS and PFS in patients with advanced HCC after triple therapy were 16.9 months and 7.3 months, while our results obtained a slightly higher values. Wu et al 29 demonstrated that drug-eluting bead TACE combined with lenvatinib and ICIs results in a higher ORR of 82.9%, a DCR of 91.4%, and a median PFS of 9.0 months in 35 patients with unresectable HCC. The differences in the results might be attributed to different baseline characteristics among the studies.…”

Lenvatinib‑based treatment regimens in conversion therapy of unresectable hepatocellular carcinoma: A systematic review and meta‑analysis

“…All 12 subgroups of studies reported the conversion rate and ORR, whereas 11 subgroups from nine studies reported the DCR, and eight studies provided data on the incidence of grade ≥3 AEs. Regarding the treatment strategies, three subgroups adopted LEN + LRT ( 12 , 25 , 39 ) and nine subgroups adopted LEN + ICI + LRT ( 12 , 24 – 26 , 45 – 49 ). Among the nine studies that used TACE, two utilized drug-eluting bead TACE ( 39 , 49 ).…”

Immunotherapy in gastric cancer with liver metastasis: Challenges and opportunities

“…Local treatments, such as transarterial chemoembolization (TACE), induce tumor necrosis, exposing a large amount of tumor antigen and initiating the immune response cycle[ 21 , 22 ]. In a study involving patients diagnosed with unresectable HCC, the combination of lenvatinib (anti-VEGF) and PD-1 inhibitors after drug-eluting bead TACE (DEB-TACE) resulted in higher objective response rates and surgical conversion rates[ 23 ].…”