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. 2023 Sep 25;23(1):91.
doi: 10.1186/s40644-023-00604-4.

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

Yongjian Guo #  1   2 , Jingqiang Wu #  1   2 , Licong Liang #  1   2 , Kangshun Zhu  1   2 , Jingwen Zhou  1   2 , Liteng Lin  1   2 , Ye Chen  1   2 , Bihui Cao  1   2 , Mingji He  1   2 , Hui Lian  1   2 , Wensou Huang  3   4 , Mingyue Cai  5   6
Affiliations

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

Yongjian Guo et al. Cancer Imaging. .

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.

Keywords: Brachytherapy; Combined modality therapy; Hepatocellular carcinoma; Therapeutic chemoembolization; Tyrosine kinase inhibitor.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of patient selection. HCC hepatocellular carcinoma, TACE transarterial chemoembolization, TKI-I tyrosine-kinase inhibitor combined with iodine-125 seed brachytherapy, TKI tyrosine-kinase inhibitor, HAIC hepatic arterial infusion chemotherapy, PT prothrombin time
Fig. 2
Fig. 2
Kaplan-Meier curves for overall survival in the matched cohort according to treatment modality. TKI-I tyrosine-kinase inhibitor combined with iodine-125 seed brachytherapy, TKI tyrosine-kinase inhibitor
Fig. 3
Fig. 3
Kaplan-Meier curves for time to progression of (A) overall tumor, (B) intrahepatic tumor and (C) vascular tumor thrombus in the matched cohort according to treatment modality. TKI-I tyrosine-kinase inhibitor combined with iodine-125 seed brachytherapy, TKI tyrosine-kinase inhibitor
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