Tenofovir versus Entecavir on Outcomes of Hepatitis B Virus-Related Hepatocellular Carcinoma After FOLFOX-Hepatic Arterial Infusion Chemotherapy

Zhikai Zheng; Jiongliang Wang; Tianqing Wu; Minrui He; Juncheng Wang; Yangxun Pan; Jinbin Chen; Dandan Hu; Li Xu; Yaojun Zhang; Minshan Chen; Zhongguo Zhou

doi:10.2147/JHC.S436062

Tenofovir versus Entecavir on Outcomes of Hepatitis B Virus-Related Hepatocellular Carcinoma After FOLFOX-Hepatic Arterial Infusion Chemotherapy

J Hepatocell Carcinoma. 2023 Nov 30:10:2117-2132. doi: 10.2147/JHC.S436062. eCollection 2023.

Authors

Zhikai Zheng^#^{1

2}, Jiongliang Wang^#^{1

2}, Tianqing Wu^#^{1

2}, Minrui He^#^{1

2}, Juncheng Wang^{1

2}, Yangxun Pan^{1

2}, Jinbin Chen^{1

2}, Dandan Hu^{1

2}, Li Xu^{1

2}, Yaojun Zhang^{1

2}, Minshan Chen^{1

2}, Zhongguo Zhou^{1

2}

Affiliations

¹ Department of Liver Surgery, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China.
² Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China.

^# Contributed equally.

Abstract

Purpose: The efficacy of entecavir (ETV) versus tenofovir (TDF) on the prognosis of hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) patients who underwent FOLFOX-hepatic arterial infusion chemotherapy (HAIC) remains unclear. In this study, we compared the outcomes between ETV and TDF in HBV-related advanced HCC patients who underwent FOLFOX-HAIC.

Methods: A total of 683 patients diagnosed with HBV-related HCC who underwent FOLFOX-HAIC and received TDF or ETV between January 2016 and December 2021 were included. Overall survival (OS), progression-free survival (PFS), HBV reactivation, and liver function of patients were compared between the ETV and TDF groups by propensity score matching (PSM).

Results: In the PSM cohort, for all patients and patients with ≥ 4 cycles of FOLFOX-HAIC, the median OS in the ETV group (15.2 months, 95% CI: 13.0-17.4 months; 16.6 months, 95% CI: 14.8-18.5 months; respectively) was shorter than that in the TDF group (23.0 months, 95% CI: 10.3-35.6 months; 27.3 months, 95% CI: 16.5-NA months; p=0.024, p=0.028; respectively). The median PFS in the ETV group (8.7 months, 95% CI: 7.9-9.5 months; 8.9 months, 95% CI: 8.0-9.8 months; respectively) was also shorter than that in the TDF group (11.8 months, 95% CI: 8.0-15.6 months; 12.7 months, 95% CI: 10.8-14.6 months; p=0.036, p=0.025; respectively). The rate of HBV reactivation in the ETV group was higher than that in the TDF group (12.3% vs 6.3%, p=0.040; 16.5% vs 6.2%, p=0.037, respectively). For liver function, the rate of ALBI grade that remained stable or improved in the ETV group was lower than that in the TDF group (44.6% vs 57.6%, p=0.006; 37.2% vs 53.8%, p=0.019, respectively).

Conclusion: Compared with ETV, TDF was associated with a better prognosis, lower proportion of HBV reactivation, and better preservation of liver function in advanced HBV-HCC patients who underwent FOLFOX-HAIC, especially those who received ≥ 4 cycles.

Keywords: entecavir; hepatic arterial infusion chemotherapy; hepatitis B virus; hepatocellular carcinoma; tenofovir.

Grants and funding

This work was supported by the Sun Yat-sen University Cancer Center physician scientist funding (No. 16zxqk04), Wu Jieping Medical Foundation-special fund for tumor immunity (320.6705.2021-02-76), Bethune Fund-Advanced solid tumor project (STLKY2-041), Guangdong Basic and Applied Basic Research Foundation (2022A1515110961), Guangzhou Science and Technology Plan Project (2023A04J2125), and National Natural Science Foundation of China (82303893).