Late combination of transarterial chemoembolization with apatinib and camrelizumab for unresectable hepatocellular carcinoma is superior to early combination

Shuguang Ju; Chen Zhou; Junwen Hu; Yingliang Wang; Chaoyang Wang; Jiacheng Liu; Chongtu Yang; Songjiang Huang; Tongqiang Li; Yang Chen; Yaowei Bai; Wei Yao; Bin Xiong

doi:10.1186/s12885-022-09451-1

Late combination of transarterial chemoembolization with apatinib and camrelizumab for unresectable hepatocellular carcinoma is superior to early combination

BMC Cancer. 2022 Mar 27;22(1):335. doi: 10.1186/s12885-022-09451-1.

Authors

Shuguang Ju^#^{1

2}, Chen Zhou^#^{1

2}, Junwen Hu^#³, Yingliang Wang^{1

2}, Chaoyang Wang^{1

2}, Jiacheng Liu^{1

2}, Chongtu Yang^{1

2}, Songjiang Huang^{1

2}, Tongqiang Li^{1

2}, Yang Chen^{1

2}, Yaowei Bai^{1

2}, Wei Yao^{1

2}, Bin Xiong^{4

5}

Affiliations

¹ Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
² Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China.
³ Department of Oncology, The Third People's Hospital of Yibin, Sichuan, 644000, China.
⁴ Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China. herr_xiong@126.com.
⁵ Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China. herr_xiong@126.com.

^# Contributed equally.

Abstract

Objective: The purpose of this study was to explore the efficacy and safety of transarterial chemoembolization (TACE) combined with apatinib and camrelizumab (TACE + AC) for unresectable hepatocellular carcinoma (HCC), and the impact of the timing of the combination on it.

Methods: In this single-arm retrospective study, consecutive data of patients with unresectable HCC treated to our hospital from March 2017 to September 2021 were collected. These patients were treated with TACE and started on camrelizumab and apatinib within one week of TACE. Camrelizumab 200 mg intravenously once every three weeks and apatinib 250 mg orally once daily. Repeat TACE treatment was available on an on-demand basis. The primary endpoints were overall survival (OS) and progression-free survival (PFS). Secondary endpoints included objective response rate (ORR), disease control rate (DCR), and safety. The univariate and multivariate Cox regression analyses were used to assess the effect of early and late combination on OS and PFS.

Results: A total of 80 patients were enrolled in this study. The median OS was 22.1 months (95% confidence interval [CI]: 13.8-30.5 months) and the median PFS was 15.7 months (95% CI: 14.7-16.6 months). The ORR was 58.8% (95% CI: 47.2-69.6) and DCR reached 81.2% (95% CI: 71.0-89.1). Multivariable Cox proportional hazard regression analyses showed that TACE late combined with apatinib and camrelizumab provided better OS than early combination (HR = 0.175, 95% CI:0.060-0.509, P = 0.001), as did PFS (HR = 0.422, 95% CI:0.184-0.967, P = 0.041). All treatment-related adverse events were tolerable, and no serious adverse events were observed.

Conclusion: TACE combined with apatinib plus camrelizumab for patients with unresectable HCC has promising antitumor activity and a manageable safety profile. For unresectable HCC with large tumor burden, late combination provides better OS and PFS compared to early combination.

Keywords: Apatinib; Hepatocellular carcinoma; Immunotherapy; Prognosis; Transarterial chemoembolization.

MeSH terms

Antibodies, Monoclonal, Humanized
Carcinoma, Hepatocellular* / drug therapy
Chemoembolization, Therapeutic* / adverse effects
Combined Modality Therapy
Humans
Liver Neoplasms* / drug therapy
Pyridines
Retrospective Studies

Substances

Antibodies, Monoclonal, Humanized
Pyridines
apatinib
camrelizumab

Abstract

MeSH terms

Substances

Grants and funding