Safety and efficacy of lenvatinib combined with camrelizumab plus transcatheter arterial chemoembolization for unresectable hepatocellular carcinoma: A two-center retrospective study

Abstract

ObjectivesTo compare the safety and efficacy of lenvatinib (LEN) combined with camrelizumab plus transcatheter arterial chemoembolization (TACE-LEN-C) and TACE combined with LEN (TACE-LEN) in patients with unresectable hepatocellular carcinoma (uHCC).MethodsEighty-three patients with uHCC treated with TACE-LEN-C or TACE-LEN from September 2018 to May 2021 were enrolled in this retrospective study. Overall survival (OS), progression-free survival (PFS), local tumor response, and adverse events (AEs) were evaluated. Univariate and multivariate analyses were used to determine the factors affecting survival.ResultsThere were 31 patients in the TACE-LEN-C group and 52 patients in the TACE-LEN group. The median follow-up period was 14.2 months (range 7.2–25.2 months) in the whole study. The combination of triple therapy was found to significantly prolong the PFS (12.5 months vs. 6.6 months, P<0.001) and OS (18.9 months vs. 13.9 months, P<0.001. In terms of tumor response, the combination demonstrated a higher objective response rate (71% vs. 42.3% by the modified Response Evaluation Criteria in Solid Tumors, P=0.023) without a statistically significant difference in the disease control rate (93.5% in TACE-LEN-C, 80.8% in TACE-LEN, P=0.195). In the multivariate analysis, two independent factors affecting PFS were identified: number of tumors and treatment. Three independent factors affected OS: number of tumors, Barcelona Clinic Liver Cancer (BCLC) stage, and treatment. All the AEs were tolerable.ConclusionTACE-LEN-C is a safe and effective treatment for patients with uHCC, and could be a potential treatment option.

Prediction of early treatment response to the combination therapy of TACE plus lenvatinib and anti-PD-1 antibody immunotherapy for unresectable hepatocellular carcinoma: Multicenter retrospective study

“…To reduce tumor burden and improve u-HCC prognosis, various combination regimens, including systemic and locoregional therapies, are now used. Our previous study found that the ORR after triple therapy was 80.6% (TACE, lenvatinib, and Anti-PD-1 antibody immunotherapy) (13)(14)(15)(16)(17). Despite the triple therapy, several patients experienced disease progression.…”

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.…”

Neutrophil-to-lymphocyte ratio predicts therapy outcomes of transarterial chemoembolization combined with tyrosine kinase inhibitors plus programmed cell death ligand 1 antibody for unresectable hepatocellular carcinoma

“…Among cancers, uHCC has one of the worst prognoses due to drug resistance, frequent recurrence, and metastasis [30]. Recently, a new combination strategy combining TACE + TKIs + ICIs has shown promising results, but not all patients benefit, and the high cost can be a significant concern [13,15]. Therefore, it is important to identify the patients who are most likely to benefit from this combination therapy.…”

“…In addition, previous studies demonstrated that incomplete embolization could cause an increase in programmed cell death ligand 1 and vascular endothelial growth factor (VEGF) [11,12] levels. Thus, many studies have focused on the combination of tailored tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs) plus TACE (TACE + TKIs + ICIs), demonstrating significantly higher tumor response and survival benefits [13][14][15]. Some studies have shown that inflammation is involved in the development and progression of HCC [16,17].…”