Tyrosine-kinase inhibitor combined with iodine-125 seed brachytherapy for hepatocellular carcinoma refractory to transarterial chemoembolization: a propensity-matched study

Abstract

Purpose To investigate the efficacy and safety of tyrosine-kinase inhibitor (TKI) combined with iodine-125 seed brachytherapy (TKI-I) versus TKI alone for patients with hepatocellular carcinoma (HCC) refractory to transarterial chemoembolization (TACE). Methods Data of patients with TACE-refractory HCC who received TKI (sorafenib or lenvatinib) or TKI-I from September 2018 to December 2020 were retrospectively analyzed. A propensity score matching (PSM) was performed to diminish potential bias. The primary endpoints were overall survival (OS) and time to progression (TTP). Tumor responses and treatment-related adverse events (TRAEs) were also compared between the two groups. Results A total of 132 patients were included in this study. Under PSM, 48 paired patients were selected for comparison. The median OS was 23.2 (95% CI 20.9–25.1) months in the TKI-I group versus 13.9 (95% CI 11.1–16.7) months in the TKI group (P < 0.001). The median TTP was 12.8 (95% CI 10.1–15.5) months in the TKI-I group versus 5.8 (95% CI 5.0-6.6) months in the TKI group (P < 0.001). Patients in the TKI-I group had higher objective response rate (68.8% vs. 33.3%, P = 0.001) and disease control rate (89.6% vs. 66.7%, P = 0.007) than those in the TKI group. The incidence and severity of TRAEs in the TKI-I group were comparable to those in the TKI group (any grade, 89.7% vs. 92.2%, P = 0.620; ≥grade 3, 33.8% vs. 32.8%, P = 0.902). Conclusions TKI-I was safe and significantly improved survival over TKI alone in HCC patients with TACE refractoriness.

Pathologically successful conversion hepatectomy for advanced giant hepatocellular carcinoma after multidisciplinary therapy: A case report and review of literature

“…TACE involves the use of a mixture of chemical drugs and iodized oil or drug-loaded microspheres to block tumor blood supply vessels, and these microspheres continuously release high concentrations of chemotherapeutic drugs to cause tumor ischemia necrosis and shrinkage[ 34 ]. In addition, TACE may improve the immune microenvironment of tumors and stimulate the exposure of neoantigens to enhance the effectiveness of immunotherapy, and the antitumor angiogenesis effect of targeted therapy and immunotherapy may also help reduce the recurrence of tumors caused by tumor angiogenesis after TACE[ 35 ]. On the other hand, HAIC involves selective insertion of a catheter into the hepatic artery without embolization or continuous infusion of chemotherapy drugs alone.…”

Application of radioactive iodine-125 microparticles in hepatocellular carcinoma with portal vein embolus

“…Primary hepatocellular carcinoma (PHC) is a common malignant tumor with high morbidity and mortality[ 1 - 3 ]. PHC patients often have portal vein tumor thrombosis (PVTTs), which are risk factors for tumor recurrence, metastasis and blood-borne transmission[ 4 - 6 ].…”