Transarterial Chemoembolization Plus Lenvatinib and PD-1 Inhibitors for Hepatocellular Carcinoma with Main Trunk Portal Vein Tumor Thrombus: A Multicenter Retrospective Study

Shu-Qun Li; Jun-Yi Wu; Jia-Yi Wu; Huang Xie; Jin-Hai Li; Zhen-Xin Zeng; Yang-Kai Fu; De-Yi Liu; Han Li; Wei-Zhao Chen; Jing-Yao Huang; Mao-Lin Yan

doi:10.2147/JHC.S428980

Transarterial Chemoembolization Plus Lenvatinib and PD-1 Inhibitors for Hepatocellular Carcinoma with Main Trunk Portal Vein Tumor Thrombus: A Multicenter Retrospective Study

J Hepatocell Carcinoma. 2023 Oct 11:10:1799-1811. doi: 10.2147/JHC.S428980. eCollection 2023.

Authors

Shu-Qun Li^#^{1

2

3}, Jun-Yi Wu^#^{1

2}, Jia-Yi Wu^#^{1

2}, Huang Xie^#⁴, Jin-Hai Li^{1

2}, Zhen-Xin Zeng^{1

2}, Yang-Kai Fu^{1

2}, De-Yi Liu^{1

2}, Han Li^{1

2}, Wei-Zhao Chen^{1

2}, Jing-Yao Huang⁴, Mao-Lin Yan^{1

2}

Affiliations

¹ Department of Hepatobiliary Pancreatic Surgery, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian Province, 350001, People's Republic of China.
² Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, Fujian Province, 350001, People's Republic of China.
³ Department of Hepatobiliary Pancreatic Surgery, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi Province, 450001, People's Republic of China.
⁴ Department of Interventional Radiology, Fujian Medical University Union Hospital, Fuzhou, 350001, People's Republic of China.

^# Contributed equally.

Abstract

Purpose: In recent years, immune checkpoint inhibitors have been used in combination with tyrosine kinase inhibitors and local therapies, creating a new era in treating hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT). However, the benefits of this triple therapy remain unclear. Thus, this study evaluated whether the combination of transarterial chemoembolization (TACE), lenvatinib, and programmed death-1 (PD-1) inhibitors (triple therapy) was effective and safe for unresectable HCC with main trunk portal vein tumor thrombus (Vp4).

Patients and methods: This study enrolled patients receiving triple therapy at four institutions between August 2018 and April 2022. Patient characteristics and course of treatment were extracted from patient records. Tumors and tumor thrombus response were evaluated using an HCC-specific modified RECIST. Kaplan-Meier curve analysis demonstrated overall survival (OS) and progression-free survival (PFS). Adverse events (AEs) were evaluated according to the National Cancer Institute Common Terminology Criteria for Adverse Events, version 5.0.

Results: Median follow-up duration was 18 (4.0-26.3) months. Overall, 41 patients with HCC and Vp4 receiving first-line triple therapy were enrolled. The intrahepatic tumor objective response rate was 68.3%. The median OS was 21.7 (range, 2.8-30.5) months, whereas the median PFS was 14.5 (range, 1.3-27.6) months. Twelve patients received sequential resections. Resection was independently associated with favorable OS and PFS. Fever (31.7%), hypertension (26.8%), fatigue (24.4%), abnormal liver function (63.4%) and decreased appetite (21.9%) were the AEs frequently associated with treatment. No treatment-related mortality occurred.

Conclusion: TACE plus lenvatinib and PD-1 inhibition was effective and tolerable for treating unresectable HCC with Vp4, with a high tumor response rate and favorable prognosis.

Keywords: hepatic cellular carcinoma; lenvatinib; main trunk portal vein; programmed death 1 inhibitor; transarterial chemoembolization; triple therapy.

Grants and funding

This study was financially supported by the Medical Innovation Project of Health and Family Planning Commission of Fujian Province (Grant number: 2022CXA002).