Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Apr 15, 2024; 16(4): 1236-1247
Published online Apr 15, 2024. doi: 10.4251/wjgo.v16.i4.1236
Efficacy and predictive factors of transarterial chemoembolization combined with lenvatinib plus programmed cell death protein-1 inhibition for unresectable hepatocellular carcinoma
Kun-Peng Ma, Jin-Xin Fu, Feng Duan, Mao-Qiang Wang
Kun-Peng Ma, Jin-Xin Fu, Feng Duan, Mao-Qiang Wang, Department of Interventional Radiology, The Fifth Medical Center of Chinese People's Liberation Army General Hospital, Beijing 100853, China
Kun-Peng Ma, Chinese People's Liberation Army Medical School, Beijing 100853, China
Author contributions: Wang MQ contributed to the conception and design; Ma KP and Fu JX contributed to the analysis and interpretation of data; Ma KP and Duan F contributed to the writing, review, and/or revision of the manuscript; All authors contributed to the acquisition of data (acquired and managed patients) and final approved the manuscript.
Institutional review board statement: This study was reviewed and approved by the Institutional Review Board of the Chinese People's Liberation Army General Hospital.
Informed consent statement: As the study used anonymous and pre-existing data, the requirement for the informed consent from patients was waived.
Conflict-of-interest statement: The authors have no relevant financial or non-financial interests to disclose.
Data sharing statement: The authors declare that all data and materials supporting the findings of this study are available within the article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mao-Qiang Wang, MD, PhD, Deputy Director, Department of Interventional Radiology, The Fifth Medical Center of Chinese People's Liberation Army General Hospital, No. 28 Fuxin Road, Haidian District, Beijing 100853, China. wangmaoqiang301@163.com
Received: October 4, 2023
Peer-review started: October 4, 2023
First decision: December 18, 2023
Revised: December 29, 2023
Accepted: February 18, 2024
Article in press: February 18, 2024
Published online: April 15, 2024
Processing time: 189 Days and 12.9 Hours
Abstract
BACKGROUND

The efficacy and safety of transarterial chemoembolization (TACE) combined with lenvatinib plus programmed cell death protein-1 (PD-1) for unresectable hepatocellular carcinoma (HCC) have rarely been evaluated and it is unknown which factors are related to efficacy.

AIM

To evaluate the efficacy and independent predictive factors of TACE combined with lenvatinib plus PD-1 inhibitors for unresectable HCC.

METHODS

This study retrospectively enrolled patients with unresectable HCC who received TACE/lenvatinib/PD-1 treatment between March 2019 and April 2022. Overall survival (OS) and progression-free survival (PFS) were determined. The objective response rate (ORR) and disease control rate (DCR) were evaluated in accordance with the modified Response Evaluation Criteria in Solid Tumors. Additionally, the prognostic factors affecting the clinical outcome were assessed.

RESULTS

One hundred and two patients were enrolled with a median follow-up duration of 12.63 months. The median OS was 26.43 months (95%CI: 17.00-35.87), and the median PFS was 10.07 months (95%CI: 8.50-11.65). The ORR and DCR were 61.76% and 81.37%, respectively. The patients with Barcelona Clinic Liver Cancer Classification (BCLC) B stage, early neutrophil-to-lymphocyte ratio (NLR) response (decrease), or early alpha-fetoprotein (AFP) response (decrease > 20%) had superior OS and PFS than their counterparts.

CONCLUSION

This study showed that TACE/lenvatinib/PD-1 treatment was well tolerated with encouraging efficacy in patients with unresectable HCC. The patients with BCLC B-stage disease with early NLR response (decrease) and early AFP response (decrease > 20%) may achieve better clinical outcomes with this triple therapy.

Keywords: Transarterial chemoembolization; Efficacy; Lenvatinib; Programmed cell death protein-1 inhibitors; Unresectable hepatocellular carcinoma

Core Tip: Transarterial chemoembolization/lenvatinib/programmed cell death protein-1 combined treatment was well tolerated with encouraging efficacy in unresectable hepatocellular carcinoma patients. The patients with Barcelona Clinic Liver Cancer Classification (BCLC) B, with early neutrophil-to-lymphocyte ratio (NLR) response (decrease) and early alpha fetoprotein (AFP) response (decrease > 20%) might achieve better clinical outcomes with this triple therapy. It is advisable that BCLC stage, NLR, and AFP should be considered at clinical decision-making in order to obtain better prognosis.