Survival Benefit of Hepatic Arterial Infusion Chemotherapy over Sorafenib in the Treatment of Locally Progressed Hepatocellular Carcinoma

Abstract

BACKROUND: Not all patients with hepatocellular carcinoma (HCC) benefit from treatment with molecular targeted agents such as sorafenib. We investigated whether New-FP (fine-powder cisplatin and 5-fluorouracil), a hepatic arterial infusion chemotherapy regimen, is more favorable than sorafenib as an initial treatment for locally progressed HCC. METHODS: To avoid selection bias, we corrected the data from different facilities that did or did not perform New-FP therapy. In total, 1709 consecutive patients with HCC initially treated with New-FP or sorafenib; 1624 (New-FP, n = 644; sorafenib n = 980) were assessed. After propensity score matching (PSM), overall survival (OS) and prognostic factors were assessed (n = 344 each). Additionally, the patients were categorized into four groups: cohort-1 [(without macrovascular invasion (MVI) and extrahepatic spread (EHS)], cohort-2 (with MVI), cohort-3 (with EHS), and cohort-4 (with MVI and EHS) to clarify the efficacy of each treatment. RESULTS: New-FP prolonged OS than sorafenib after PSM (New-FP, 12 months; sorafenib, 7.9 months; p < 0.001). Sorafenib treatment, and severe MVI and EHS were poor prognostic factors. In the subgroup analyses, the OS was significantly longer the New-FP group in cohort-2. CONCLUSIONS: Local treatment using New-FP is a potentially superior initial treatment compared with sorafenib as a multidisciplinary treatment in locally progressed HCC without EHS.

Portal Vein Tumor Thrombosis and Hepatocellular Carcinoma – The Changing Tides

“…The median survival time (MST) after propensity score was 15 months versus 7.9 months for the New-FP (n=442) and sorafenib groups (n=149), respectively (P<0.001). 113 Similarly, HAIC with low dose 5-FU and cisplatin (LFP) as a first-line treatment for HCC patients with PVTT (VP3, VP4) has also been proposed while switching to sorafenib if no response is observed. [114][115][116] The survival time in the HAIC (n=32) group was significantly longer versus the sorafenib (n=14) groups (309 days vs 120 days).…”

Controlling Major Portal Vein Invasion Progression during Lenvatinib Treatment by Carbon-Ion Radiotherapy in Patients with Advanced Hepatocellular Carcinoma

“…In the present case, HAIC was selected as the first treatment at the time MVI was recognized. Several recent reports have demonstrated that HAIC has survival benefits compared with sorafenib, which had been a standard first-line systemic therapy, until the approval of atezolizumab plus bevacizumab, in patients with advanced disease with MVI without extrahepatic metastasis [27,28]. After discontinuation of HAIC, the patient moved on to lenvatinib, which was the standard systemic therapy like sorafenib at that time [24][25][26].…”

Clinical Importance of Regimens in Hepatic Arterial Infusion Chemotherapy for Advanced Hepatocellular Carcinoma with Macrovascular Invasion

“…We describe a regimen for HAIC named "New FP" for the treatment of advanced HCC [19][20][21][22]. New FP is a regimen that consists of a fine-powder CDDP suspended with lipiodol and 5-FU.…”

“…New FP is a regimen that consists of a fine-powder CDDP suspended with lipiodol and 5-FU. We have previously reported the therapeutic outcomes of New FP in a single-center analysis and multi-center analysis [19,20,22]. Moreover, a non-randomized multi-center phase 2 trial of New FP and sorafenib in the treatment of HCC has also been reported [21].…”