The Efficacy of TACE Combined With Lenvatinib Plus Sintilimab in Unresectable Hepatocellular Carcinoma: A Multicenter Retrospective Study

Cao, Fei; Yang, Yi; Si, Tongguo; Luo, Jun; Zhou, Hui; Zhang, Zhewei; Feng, Dan; Chen, Yi; Zheng, Jiaping

doi:10.3389/fonc.2021.783480

Cited by 48 publications

(53 citation statements)

References 34 publications

(41 reference statements)

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“…This real-world retrospective study showed significantly better overall survival and tumor response rate outcomes with TACE plus apatinib plus camrelizumab than with apatinib plus camrelizumab in patients with unresectable HCC. Cao et al (24) reported TACE combined with lenvatinib and sintilimab for unresectable HCC with a median OS of 23.6 months and ORR of 46.7%, which is similar to our results. These suggest that TACE combined with targeted therapy plus immunotherapy is a promising treatment option in unresectable HCC.…”

Section: Safetysupporting

confidence: 91%

Apatinib Plus Camrelizumab With/Without Chemoembolization for Hepatocellular Carcinoma: A Real-World Experience of a Single Center

Zhou

Yang

et al. 2022

Front. Oncol.

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ObjectiveThis study was conducted in order to compare the efficacy and safety of transarterial chemoembolization (TACE) plus apatinib plus camrelizumab (TACE+AC) and apatinib plus camrelizumab (AC) in the treatment of unresectable hepatocellular carcinoma (HCC) in a real-world setting.MethodsIn this single-center retrospective study, the data of patients with unresectable HCC who had received TACE+AC or AC treatment during March 2017 to May 2021 were assessed. Patients in the AC group received intravenous administration of camrelizumab 200 mg every 3 weeks and oral apatinib 250 mg/day treatment. Patients in the TACE+AC group received the same dose of camrelizumab and apatinib 1 week after TACE. The primary endpoint of the study was overall survival (OS), objective response rate (ORR), disease control rate (DCR), and adverse events (AEs) as the secondary endpoints.ResultsA total of 108 patients were enrolled in the study. There were 52 patients in the AC group and 56 patients in TACE+AC group. Median OS was significantly longer in the TACE+AC group than in the AC group (24.8 vs. 13.1 months; P = 0.005). Patients in the TACE+AC group achieved a higher ORR [24 (42.9%) vs. 9 (17.3%), P = 0.004] than those in the AC group. Patients in the TACE+AC group also achieved a higher disease control rate (DCR) [48 (85.7%) vs. 30 (57.7%), P = 0.001] than patients in the AC group. There was no significant difference in the incidence of AEs related to apatinib and camrelizumab between the two groups, except for gastrointestinal reaction (P > 0.05, all; P < 0.05, gastrointestinal reaction).ConclusionTACE plus apatinib plus camrelizumab significantly improved OS, ORR, and DCR over apatinib plus camrelizumab in patients with unresectable HCC. AEs were tolerable and manageable.

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Section: Safetysupporting

confidence: 91%

Apatinib Plus Camrelizumab With/Without Chemoembolization for Hepatocellular Carcinoma: A Real-World Experience of a Single Center

Zhou

Yang

et al. 2022

Front. Oncol.

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“…Therefore, the combination of TACE, lenvatinib and PD-1 inhibitor may bring about a synergistic antitumor activity, contributing to improved clinical outcomes in advanced HCC patients. Previous studies (29,30) have assessed the combination of TACE, lenvatinib and PD-1 inhibitor for patients with unresectable HCC and reported a PFS of 11.4-13.3 months and an OS of 23.6-24.0 months, which seemed much longer than those for the patients treated with TACE-L-P in our study. However, it was worth noting that these studies enrolled a large proportion (25.0%-54.5%) of patients with HCC at BCLC stage B, who were expected to achieve better outcomes than those with BCLC stage C HCC in the present study.…”

Section: Discussioncontrasting

confidence: 49%

Transarterial Chemoembolization Combined With Lenvatinib Plus PD-1 Inhibitor for Advanced Hepatocellular Carcinoma: A Retrospective Cohort Study

Cai

Huang

et al. 2022

Front. Immunol.

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PurposeTo investigate the efficacy and safety of transarterial chemoembolization (TACE) combined with lenvatinib plus PD-1 inhibitor (TACE-L-P) versus TACE combined with lenvatinib (TACE-L) for patients with advanced hepatocellular carcinoma (HCC).Materials and MethodsData of advanced HCC patients treated with TACE-L-P (TACE-L-P group) or TACE-L (TACE-L group) from January 2019 to December 2020 were prospectively collected and retrospectively analyzed. The differences in overall survival (OS), progression-free survival (PFS), tumor responses (based on modified Response Evaluation Criteria in Solid Tumors) and adverse events (AEs) were compared between the two groups. Potential factors affecting OS and PFS were determined.ResultsA total of 81 patients were included in this study. Among them, 41 received TACE-L-P and 40 received TACE-L. The patients in TACE-L-P group had prolonged OS (median, 16.9 vs. 12.1 months, P=0.009), longer PFS (median, 7.3 vs. 4.0 months, P=0.002) and higher objective response rate (56.1% vs. 32.5%, P=0.033) and disease control rate (85.4% vs. 62.5%, P=0.019) than those in TACE-L group. Multivariate analyses revealed that the treatment option of TACE-L, main portal vein invasion and extrahepatic metastasis were the independent risk factors for OS, while TACE-L and extrahepatic metastasis were the independent risk factors for PFS. In subgroup analyses, a superior survival benefit was achieved with TACE-L-P in patients with extrahepatic metastasis or tumor number >3 but not in those with main portal vein invasion. The incidence and severity of AEs in TACE-L-P group were comparable to those in TACE-L group (any grade, 92.7% vs. 95.0%, P=1.000; grade 3, 36.6% vs. 32.5%, P=0.699).ConclusionTACE-L-P significantly improved survival over TACE-L with an acceptable safety profile in advanced HCC patients, especially those with extrahepatic metastasis or tumor number >3 but without main portal vein invasion.

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“…Molecular targeted drugs, as multikinase inhibitors, may inhibit tumor angiogenesis and tumor cell proliferation [ 6 ], among which lenvatinib proved to prolong the progression-free survival (PFS) of patients with intermediate-stage HCC refractory to TACE [ 7 ] and was approved for first-line treatment of unresectable hepatocellular carcinoma (uHCC) based on the REFLECT study [ 8 ]. Meanwhile, sintilimab is a human immunoglobulin G4 (IgG4) monoclonal antibody that specifically binds to the programmed death-1 (PD-1) molecule on the surface of T-cells, consequently blocking the tumor immune tolerance-inducing PD-1/programmed death-ligand 1 (PD-L1) pathway, reactivating the antitumor activities of lymphocytes, and inhibiting tumors [ 9 ]. Application of anti-PD-1/PD-L1 antibodies as checkpoint inhibitors is rapidly becoming a promising therapeutic approach in treating tumors, and some of them have successfully been commercialized in the past few years [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Efficacy Investigation of TACE Combined with Lenvatinib and Sintilimab in Intermediate-Stage Hepatocellular Carcinoma

et al. 2022

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Objective. To evaluate the effectiveness of transarterial chemoembolization (TACE) combined with lenvatinib and sintilimab in treating patients with midstage hepatocellular carcinoma (HCC). Methods. Sixty-two patients with midstage HCC were enrolled in this study. All of them were firstly treated in our hospital between September 1, 2019, and March 1, 2020. According to different treatment regimens, they were divided into the control group (31 cases, TACE group) and the observation group (31 cases, TACE combined with lenvatinib and sintilimab group). Each patient was followed up for at least 30 months to compare the short-term clinical efficacy and survival rate between the two groups. Results. The objective response rate (ORR) and disease control rate (DCR) of the observation group at 3 months were 77.4% and 93.5%, respectively, which were higher than those of the control group ( P < 0.05 ). The 2-year cumulative overall survival rate of the observation group was 64.5%, which was significantly higher than that of the control group ( P < 0.05 ). The survival curve of the disease-free survival rate in the observation group was higher than that in the control group, and the difference was statistically significant ( X 2 = 4.313 , P < 0.05 ). Conclusion. TACE combined with lenvatinib and sintilimab in the treatment of Barcelona Clinic Liver Cancer (BCLC) stage B hepatocellular carcinoma can effectively control the tumor progression and prolong the survival time of patients. Those preliminary findings need validation in larger studies, with a prospective design and longer follow-up.

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The Efficacy of TACE Combined With Lenvatinib Plus Sintilimab in Unresectable Hepatocellular Carcinoma: A Multicenter Retrospective Study

Cited by 48 publications

References 34 publications

Apatinib Plus Camrelizumab With/Without Chemoembolization for Hepatocellular Carcinoma: A Real-World Experience of a Single Center

Apatinib Plus Camrelizumab With/Without Chemoembolization for Hepatocellular Carcinoma: A Real-World Experience of a Single Center

Transarterial Chemoembolization Combined With Lenvatinib Plus PD-1 Inhibitor for Advanced Hepatocellular Carcinoma: A Retrospective Cohort Study

Efficacy Investigation of TACE Combined with Lenvatinib and Sintilimab in Intermediate-Stage Hepatocellular Carcinoma

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