Real-world study of hepatic artery infusion chemotherapy combined with anti-PD-1 immunotherapy for hepatocellular carcinoma patients with portal vein tumor thrombus

Jinghuan Li; Bing Quan; Wenfeng Liu; Menglong Zhao; Fan Yao; Rongxin Chen; Zhenggang Ren; Xin Yin

doi:10.1177/17588359241231252

Real-world study of hepatic artery infusion chemotherapy combined with anti-PD-1 immunotherapy for hepatocellular carcinoma patients with portal vein tumor thrombus

Ther Adv Med Oncol. 2024 Apr 11:16:17588359241231252. doi: 10.1177/17588359241231252. eCollection 2024.

Authors

Jinghuan Li^{1

2

3}, Bing Quan^{1

2

3}, Wenfeng Liu^{1

2

3}, Menglong Zhao⁴, Fan Yao^{1

2

3}, Rongxin Chen^{1

2

3}, Zhenggang Ren^{1

2

3}, Xin Yin^{1

2

3}

Affiliations

¹ Department of Hepatic Oncology, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China.
² Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Shanghai, China.
³ National Clinical Research Center for Interventional Medicine, Shanghai, China.
⁴ Department of Radiology, Zhongshan Hospital, Fudan University, and Shanghai Institute of Medical Imaging, Shanghai, China.

Abstract

Background: Patients with hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT) present a poor prognosis. Current systemic therapies offer limited benefits. Hepatic artery infusion chemotherapy (HAIC) is a local regional treatment for advanced HCC, particularly in selected patients such as patients with PVTT or high intrahepatic tumor burden.

Objectives: The purpose of this study is to retrospectively evaluate the efficacy and safety of HAIC combined with anti-PD-1 immunotherapy for HCC patients with PVTT, and explore factors related to survival prognosis, providing clues for treatment decisions for HCC patients.

Design: This is a single-center retrospective study conducted over 2 years on consecutive PVTT patients receiving HAIC combined anti-PD-1 antibodies.

Methods: The primary endpoint was overall survival (OS). Univariate and multivariate analyses were performed to identify prognostic factors affecting OS. Treatment-associated adverse events were evaluated as well.

Results: A total of 119 patients were analyzed. The median OS and PFS were 14.9 months and 6.9 months. A total of 31.1% of grade 3-4 adverse events were reported, with elevated transaminase and total bilirubin being the most common. The independent variables correlated with survival include treatment-related alpha-fetoprotein (AFP) response, the presence of extrahepatic organ metastasis, absolute value of platelet (PLT), neutrophil-to-lymphocyte ratio, and combined usage of tyrosine kinase inhibitors (TKIs).

Conclusion: In HCC patients with PVTT, combination therapy with HAIC and anti-PD-1 antibodies might be a promising therapy. The efficacy and safety of this combination protocol on patients with HCC complicated by PVTT warrants further investigation prospectively, especially in combination with TKIs.

Keywords: anti-PD-1 immunotherapy; combination therapy; hepatic artery infusion chemotherapy; hepatocellular carcinoma; portal vein tumor thrombus.