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. 2023 Jul 27:10:1209-1222.
doi: 10.2147/JHC.S417550. eCollection 2023.

Hepatic Arterial Infusion Chemotherapy Plus Lenvatinib and Tislelizumab with or Without Transhepatic Arterial Embolization for Unresectable Hepatocellular Carcinoma with Portal Vein Tumor Thrombus and High Tumor Burden: A Multicenter Retrospective Study

Song Chen  1 , Feng Shi  2 , Zhiqiang Wu  3 , Liguang Wang  4 , Hongjie Cai  3 , Ping Ma  5 , Yuanmin Zhou  5 , Qicong Mai  2 , Fan Wang  3 , Shuangyan Tang  3 , Wenquan Zhuang  3 , Jiaming Lai  6 , Xiaoming Chen  2 , Huanwei Chen  4 , Wenbo Guo  3
Affiliations

Hepatic Arterial Infusion Chemotherapy Plus Lenvatinib and Tislelizumab with or Without Transhepatic Arterial Embolization for Unresectable Hepatocellular Carcinoma with Portal Vein Tumor Thrombus and High Tumor Burden: A Multicenter Retrospective Study

Song Chen et al. J Hepatocell Carcinoma. .

Abstract

Purpose: The current therapeutic strategies for high-risk, unresectable hepatocellular carcinoma (HCC) patients demonstrate suboptimal outcomes. This study aimed to assess the clinical efficacy of the combined approach of hepatic arterial infusion chemotherapy (HAIC), lenvatinib, and tislelizumab, either with or without transhepatic arterial embolization (TAE), in managing HCC patients with portal vein tumor thrombus (PVTT) and significant tumor load.

Patients and methods: In this multicenter retrospective study, we analyzed patients diagnosed with primary, unresectable HCC presenting with PVTT and substantial tumor load who had undergone treatment with HAIC, lenvatinib, and tislelizumab, with or without TAE (referred to as the THLP or HLP group), between January 2019 and February 2022 across four medical centers in China. The outcomes included objective response rate (ORR), disease control rate (DCR), overall survival (OS), and progression-free survival (PFS).

Results: The study cohort comprised 100 patients, 50 each in the THLP and HLP groups. The THLP group demonstrated a significantly superior ORR (72% vs 52%, P=0.039). However, both groups exhibited comparable DCR (88% vs 76%, P=0.118), as assessed by the modified response evaluation criteria in solid tumors. The median OS and PFS for the entire cohort were 12.5 months (95% CI, 10.9-14.8) and 5.0 months (95% CI, 4.2-5.4), respectively. The THLP group exhibited a significantly extended OS (median, 14.1 vs 11.3 months, P=0.041) and PFS (median, 5.6 vs 4.4 months, P=0.037) in comparison to the HLP group. The most frequently reported treatment-related adverse events included abdominal pain and nausea, both reported by 59% of patients.

Conclusion: The combination of HAIC, lenvatinib, tislelizumab, and TAE was feasible in HCC patients with PVTT and high tumor burden, with tolerable safety.

Keywords: hepatic arterial infusion chemotherapy; hepatocellular carcinoma; lenvatinib; tislelizumab; transhepatic arterial embolization.

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Conflict of interest statement

All authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Patient flowchart. A patient might meet several exclusion criteria, but they were excluded only once from the uppermost criteria.
Figure 2
Figure 2
Kaplan-Meier curves of (A) overall survival in all patients; (B) progression-free survival in all patients (C) overall survival in two groups; and (D) progression-free survival in two groups.
Figure 3
Figure 3
Kaplan-Meier curves of overall survival between two groups in patients (A) with PVTT I/II; (B) with PVTT III/IV; (C) without extrahepatic metastasis; (D) with extrahepatic metastasis; (E) with AFP ≥400 ng/mL and (F) with AFP <400 ng/mL.
Figure 4
Figure 4
Kaplan-Meier curves of progression-free survival between two groups in patients (A) with PVTT I/II; (B) with PVTT III/IV; (C) without extrahepatic metastasis; (D) with extrahepatic metastasis; (E) with AFP >400 ng/mL and (F) with AFP ≤400 ng/mL.
See this image and copyright information in PMC

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