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Transarterial interventional therapy combined with tyrosine kinase inhibitors with or without anti-PD-1 antibodies as initial treatment for hepatocellular carcinoma with major portal vein tumor thrombosis: a single-center retrospective study

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Abstract

Transarterial interventional therapy combined with tyrosine kinase inhibitors (TKIs) and anti-Pd-1 antibodies (triplet regimen) has shown promising results in advanced HCC. However, the clinical utility of the triplet regimen in patients with HCC and major portal vein tumor thrombosis (PVTT) remains unclear. This study compared the efficacy and safety of the triplet regimen versus transarterial interventional therapy combined with TKIs (double regimen) for such patients. Thirty-nine patients treated with the triplet regimen were retrospectively compared with 37 patients treated with the double regimen. The objective response rate (ORR), the response rate of PVTT treatment, and safety were observed; progression-free survival (PFS) and overall survival (OS) were assessed using the Kaplan‒Meier method and log-rank test. Predictors of survival were identified using multivariate analysis. Median OS and median PFS were significantly improved in the Triplet Group compared with the Double Group (482 vs. 310 days; 208 vs. 85 days). The ORR and the response rate of PVTT were significantly higher in the Triplet Group than in the Double Group (59% vs. 35%; 62% vs. 35%). There was no significant difference in the incidence of grade 3/4 adverse events between the two groups (33% vs. 21%). The most frequent grade 3/4 adverse events were thrombocytopenia (10%) in the Triplet Group and hand–foot syndrome (14%) in the Double Group. Multivariable analysis showed that treatment method and PVTT treatment response were significant predictors of OS. The triplet regimen showed superiority over the doublet regimen in improving OS and PFS and had acceptable safety in patients with HCC and major PVTT.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

CI:

Confidence interval

DCR :

Disease control rate

ECOG :

Eastern cooperative oncology group

HAIC :

Hepatic arterial infusion chemotherapy

HCC :

Hepatocellular carcinoma

HRs:

Hazard ratios

ICIs :

Immune checkpoint inhibitors

mRECIST:

Modified RECIST

ORR :

Objective response rate

OS :

Overall survival

PFS :

Progression-free survival

PVTT:

Portal vein tumor thrombosis

RECIST:

Response evaluation criteria in solid tumors

TACE :

Transcatheter arterial chemoembolization

TME :

Tumor microenvironment

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Acknowledgements

The authors acknowledge Huining Nian, Department of Interventional Oncology, Fujian Cancer Hospital, for her support in part of the statistical work and manuscript reading. The authors also thank Yan Zhou for providing statistical consulting services from the Section of Follow-up, Fujian Cancer Hospital.

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The authors received no financial support for the research, authorship, and/or publication of this article.

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Authors and Affiliations

  1. Department of Interventional Oncology, Fujian Provincial Key Laboratory of Tumor Biotherapy, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, 350014, China

    Wenchang Yu, Weifu Liu, Kongzhi Zhang, Shiguang Chen & Xiaolong Wang

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  1. Wenchang Yu
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  2. Weifu Liu
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  3. Kongzhi Zhang
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  4. Shiguang Chen
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  5. Xiaolong Wang
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Contributions

WY initiated the study concept, coordinated the entire study, and wrote the manuscript. WL, KZ, SC, and XW collected and helped interpret the clinical data. All authors approved the final version of the article, including the authorship list.

Corresponding author

Correspondence to Wenchang Yu.

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All authors declare that there are no conflicts of interest.

Ethical approval

This study was approved by the Institutional Review Board of Fujian Cancer Hospital (K202001001).

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All patients provided written informed consent.

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Yu, W., Liu, W., Zhang, K. et al. Transarterial interventional therapy combined with tyrosine kinase inhibitors with or without anti-PD-1 antibodies as initial treatment for hepatocellular carcinoma with major portal vein tumor thrombosis: a single-center retrospective study. Cancer Immunol Immunother 72, 3609–3619 (2023). https://doi.org/10.1007/s00262-023-03511-6

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