Effect of regorafenib combined with immunotherapy and arterial chemoembolization on the survival of patients with advanced hepatocellular carcinoma: a retrospective study

Abstract

Purpose: To evaluate the effect of combining regorafenib with immunotherapy, and further adding transarterial chemoembolization (TACE), on the survival rates of patients suffering from advanced hepatocellular carcinoma (HCC).

Methods: A retrospective cohort study was conducted on clinical data from 219 patients with advanced HCC treated from January 2019 to December 2020 at Zhangzhou Affiliated Hospital of Fujian Medical University. Patients were divided into two groups: regorafenib combined with immunotherapy (Group A; n = 106) and regorafenib combined with immunotherapy plus TACE (Group B; n = 113). Assessment included baseline characteristics, serum indicators, treatment response, adverse events, progression-free survival (PFS), quality of life and overall survival (OS).

Results: Six months after treatment, Group B demonstrated a significant decrease in α-fetoprotein (AFP) levels (P < 0.001), Alanine aminotransferase (ALT) levels (P < 0.001), and aspartate Aminotransferase (AST) levels (P < 0.001), along with a significant increase in albumin (ALB) levels (P = 0.010) compared to Group A. The addition of TACE resulted in higher partial response rates (PR) (P = 0.044), disease control rates (DCR) (P = 0.005), overall response rates (ORR) (P = 0.014), improved 1- and 2-year survival rates (P = 0.019, 0.025), and 6-month PFS rates (P = 0.003). However, this combination therapy was related to a higher incidence of grade 3-4 adverse events.

Conclusion: Regorafenib combined with immunotherapy plus TACE may lead to improved short-term survival outcomes in advanced HCC patients, albeit with an increased risk of adverse events as well as possible effects on quality of life. These findings emphasize the complexity of treatment decisions in advanced HCC.

Keywords: Regorafenib; arterial chemoembolization; hepatocellular carcinoma; immunotherapy; retrospective study; survival outcomes.

Figure 1

Patient selection flowchart.

Figure 2

Comparison of serum indicators between the two groups before and 6 months after treatment. A: AFP-Baseline (ng/mL); B: AFP-After 6 months of treatment (ng/mL); C: Albumin (g/L); D: Albumin-After 6 months of treatment (g/L); E: ALT-Baseline (U/L); F: ALT-After 6 months of treatment (U/L); G: AST-Baseline (U/L); H: AST-After 6 months of treatment ((U/L). Note: AFP, α-fetoprotein; ALT, Alanine Aminotransferase; AST, Aspartate Aminotransferase. **P < 0.01, ***P < 0.001, ns: no significant difference.

Figure 3

Kaplan-Meier survival analysis of overall survival (A) and progression-free survival (B) between the two groups.