Transarterial Chemoembolization Combined with Tyrosine Kinase Inhibitors Plus Immune Checkpoint Inhibitors for Advanced Hepatocellular Carcinoma: A Propensity Score Matching Analysis

Benjian Gao; Fengyi Yang; Dongning Zheng; Shuai Hu; Jie Liu; Hong Liu; Yongfa Liu; LinXin Liu; Rui Wang; Yi Zhao; Cheng Cui; Cheng Fang; Jin Yang; Song Su; Yunwei Han; Xiaoli Yang; Bo Li

doi:10.2147/JHC.S443041

Transarterial Chemoembolization Combined with Tyrosine Kinase Inhibitors Plus Immune Checkpoint Inhibitors for Advanced Hepatocellular Carcinoma: A Propensity Score Matching Analysis

J Hepatocell Carcinoma. 2023 Dec 13:10:2265-2276. doi: 10.2147/JHC.S443041. eCollection 2023.

Authors

Benjian Gao^#^{1

2}, Fengyi Yang^#^{1

2}, Dongning Zheng^{1

2}, Shuai Hu^{1

2}, Jie Liu^{1

2}, Hong Liu^{1

2}, Yongfa Liu^{1

2}, LinXin Liu^{1

2}, Rui Wang^{1

2}, Yi Zhao^{1

2}, Cheng Cui^{1

2}, Cheng Fang^{1

2}, Jin Yang^{1

2}, Song Su^{1

2}, Yunwei Han³, Xiaoli Yang^{1

2}, Bo Li^{1

2}

Affiliations

¹ Department of General Surgery (Hepatopancreatobiliary Surgery), The Affiliated Hospital of Southwest Medical University, Luzhou, People's Republic of China.
² Academician (Expert) Workstation of Sichuan Province, Metabolic Hepatobiliary and Pancreatic Diseases Key Laboratory of Luzhou City, The Affiliated Hospital of Southwest Medical University, Luzhou, People's Republic of China.
³ Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, People's Republic of China.

^# Contributed equally.

Abstract

Purpose: This study aimed to explore the clinical efficacy of transarterial chemoembolization (TACE) in combination with tyrosine kinase inhibitors (TKIs) plus immune checkpoint inhibitors (ICIs) (triple therapy) compared to TACE alone (monotherapy) for advanced hepatocellular carcinoma (HCC).

Material and methods: Data of consecutive advanced HCC patients receiving triple therapy or monotherapy at our center between January 2019 and December 2022 were collected and retrospectively analyzed. Propensity score matching (PSM) and subgroup analyses were performed to reduce the bias between the two groups. The primary outcomes of the study were the overall survival (OS) and progression-free survival (PFS). The secondary outcomes were the objective response rate (ORR) and disease control rate (DCR).

Results: A total of 104 patients were enrolled in this study: 41 in the triple therapy group and 63 in the monotherapy group. After PSM analysis, each group included 37 patients. The median OS and PFS were significantly longer in the triple therapy group than in the monotherapy group in the whole cohort (median OS, 18.8 vs 11.7 months, P = 0.022; median PFS, 10.5 vs 6.4 months, P = 0.012) and after PSM (median OS, 19.6 vs 12.5 months, P = 0.030; median PFS, 10.5 vs 6.7 months, P = 0.008). Furthermore, the treatment modality was an independent prognostic factor for OS (hazard ratio [HR]: 0.449, 95% confidence interval [CI]: 0.240-0.840, P = 0.012) and PFS (HR: 0.406, 95% CI: 0.231-0.713, P = 0.002) according to the multivariate cox regression analysis. A greater ORR was also observed in the triple therapy group (ORR: 56.7% vs 32.4%, P = 0.035). No significant difference was observed in DCR between the two groups (83.7% vs 72.9%, P = 0.259).

Conclusion: The triple therapy was superior to the monotherapy regarding OS, PFS, and ORR of advanced HCC patients.

Keywords: efficacy; hepatocellular carcinoma; immune checkpoint inhibitors; transarterial chemoembolization; tyrosine kinase inhibitors.

Grants and funding

This study was supported by the National Natural Science Foundation of China (No. 92059207), the Key Research and Development Project of the Science & Technology Department of Sichuan Province (Nos. 2022YFS0256, Nos. 2023YFQ0101).