Published online Apr 15, 2024. doi: 10.4251/wjgo.v16.i4.1236
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
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.
To evaluate the efficacy and independent predictive factors of TACE combined with lenvatinib plus PD-1 inhibitors for unresectable HCC.
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.
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.
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.
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.