Transarterial chemoembolization plus apatinib with or without camrelizumab for unresected hepatocellular carcinoma: A two-center propensity score matching study

Abstract

PurposeTo compare the effectiveness and safety of transarterial chemoembolization (TACE) combined with apatinib and camrelizumab with those of TACE as well as apatinib among patients with unresectable hepatocellular carcinoma (HCC).Materials and methodsThe data of patients with unresectable HCC (uHCC) who received TACE-apatinib-camrelizumab combination (TACE + AC group) and TACE-apatinib combination (TACE + A group) were collected from two centers between January 2018 and January 2022. Propensity score matching (PSM) was conducted to diminish the bias between the two groups. The primary outcome measures of the study were overall survival (OS) and progression-free survival (PFS), and the secondary outcome measures were response rate (ORR), disease control rate (DCR), and adverse events (AEs).ResultsA total of 102 patients were enrolled in this study after PSM, with 34 patients in the TACE + AC group and 68 patients in the TACE + A group. Compared to the TACE + A group, TACE + AC had a significantly longer median OS (25.5 months, interquartile range [IQR], 23.5–33.0) than 18.5 months (IQR, 13.0–25.0; P = 0.001). Similarly, the PFS of the TACE + AC group was significantly improved (14.0 months, IQR, 9.0–NA) compared to that of the TACE + A group (5.0 months, IQR, 2.5–9.0; P = 0.001). The ORR rates (55.9% vs. 51.5%), and DCR rates (79.4% vs. 72.1%) were comparable between groups (P > 0.05). All treatment-related adverse events were tolerable and manageable, and no serious adverse events were observed.ConclusionTACE combined with apatinib plus camrelizumab demonstrated superior efficacy to TACE plus apatinib for patients with unresectable HCC. The two combination therapies showed similar safety profiles.

Efficacy and safety of transarterial chemoembolization combined with targeted therapy and immunotherapy versus with targeted monotherapy in unresectable hepatocellular carcinoma: A systematic review and meta-analysis

“…In terms of survival benefits, the meta-analysis results of this study showed that compared to the TACE-T, TACE-T-I significantly prolongs the PFS and OS of patients with unresectable HCC, consistent with the results of the included studies. [14][15][16][17][18]23,24,[26][27][28][29][30][31] Subgroup analysis based on different TACE types aligns with the overall pooled results, suggesting that triple treatment regimen may offer better survival benefits for patients with unresectable HCC, unaffected by TACE type. The extension of OS in the TACE-T-I group may be related to the increased ORR, DCR, and Table 3 The meta-analysis results for treatment-related adverse events (TRAEs) of any grade.…”

“…Regarding tumor response, the meta-analysis results of this study align with several studies, [14,15,27,28,31] indicating that patients receiving triple therapy (TACE-T-I) exhibit higher ORR and DCR compared to those receiving dual therapy (TACE-T). However, Zhu et al [18] found no significant differences in ORR The study by Sun et al [17] demonstrated that patients receiving triple therapy had a higher ORR than dual therapy (71% vs 42.3%; P = .023), although there was no significant difference in DCR between the 2 groups (93.5% vs 80.8%; P = .195). Also, the study by Jiang et al [16] confirmed better tumor response of patients in the TACE-T-I group than TACE-T group, with a higher ORR (52.4% vs 17.8%; P = .001), but no significant difference in DCR (83.3% vs 77.8%; P = .514).…”

“…Ultimately, 14 articles were included in the analysis. [14][15][16][17][18][23][24][25][26][27][28][29][30][31]…”

“…The included articles were published between 2021 and 2023, all originating from China. The majority of articles (n = 14) were retrospective cohort studies, [14][15][16][17][18]23,24,[26][27][28][29][30][31] and one was a prospective real-world study. [24] There were 2144 patients, with 1013 in the TACE-T-I group and 1131 in the TACE-T group.…”

“…[ 13 ] However, the differences in efficacy and safety between the dual combination (TACE-T) and the triple combination (TACE-T-I) have not yet been demonstrated. The results of these studies [ 14 – 18 ] were inconsistent. Therefore, this paper aims to conduct a systematic review and meta-analysis, consolidating relevant research evidence to evaluate whether TACE-T-I provides significant clinical benefits compared to TACE-T for patients with unresectable HCC.…”