Effects of Stereotactic Body Radiation Therapy Plus PD-1 Inhibitors for Patients With Transarterial Chemoembolization Refractory

Yan-Jun Xiang; Kang Wang; Yi-Tao Zheng; Shuang Feng; Hong-Ming Yu; Xiao-Wei Li; Xi Cheng; Yu-Qiang Cheng; Jin-Kai Feng; Li-Ping Zhou; Yan Meng; Jian Zhai; Yun-Feng Shan; Shu-Qun Cheng

doi:10.3389/fonc.2022.839605

Effects of Stereotactic Body Radiation Therapy Plus PD-1 Inhibitors for Patients With Transarterial Chemoembolization Refractory

Front Oncol. 2022 Mar 21:12:839605. doi: 10.3389/fonc.2022.839605. eCollection 2022.

Authors

Yan-Jun Xiang^{1

2}, Kang Wang¹, Yi-Tao Zheng², Shuang Feng³, Hong-Ming Yu¹, Xiao-Wei Li⁴, Xi Cheng³, Yu-Qiang Cheng¹, Jin-Kai Feng¹, Li-Ping Zhou¹, Yan Meng³, Jian Zhai⁴, Yun-Feng Shan², Shu-Qun Cheng^{1

2}

Affiliations

¹ Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China.
² Department of Hepatobiliary Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China.
³ Department of Radiotherapy, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China.
⁴ Department II of Interventional Radiology, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China.

Abstract

Background and aims: Patients with intermediate-stage hepatocellular carcinoma (HCC) who are refractory to transarterial chemoembolization (TACE) have a poor prognosis. This study aimed to explore whether stereotactic body radiation therapy (SBRT) combined with PD-1 inhibitors could improve the clinical outcomes of such patients.

Methods: This retrospective cohort study included patients with intermediate-stage HCC who were diagnosed with TACE refractoriness between January 2019 and December 2020 in the Eastern Hepatobiliary Surgery Hospital and the First Affiliated Hospital of Wenzhou Medical University. The patients were divided into two groups: (1) those who switched from TACE to receive stereotactic body radiotherapy (SBRT) combined with PD-1 inhibitors; (2) those who continued TACE treatment and added PD-1 inhibitors. Progression-free survival (PFS), overall survival (OS), and tumour response were assessed in both groups after becoming refractory to TACE treatment.

Results: Of the seventy-six patients included in this study, the median PFS was 19.6 months in the SBRT-IO group (n=31) and 10.1 months in the TACE-IO group (n=45, p<0.05). The SBRT-IO group also had a significantly higher OS than the TACE-IO group (p<0.05). The objective response rate (ORR) and disease control rate (DCR) were also better in the SBRT-IO group (ORR, 71.0% vs. 15.6%, OR=8.483, 95% CI 3.319-21.680, P < 0.001; DCR, 80.6% vs. 31.1%, OR=9.226, 95% CI 3.096-27.493, P < 0.001).

Conclusions: SBRT combined with a PD-1 inhibitor improves PFS and OS in TACE-refractory patients with intermediate-stage HCC. Therefore, this therapy is a suitable option in cases of TACE treatment failure.

Keywords: combination therapy; hepatocellular carcinoma; immunotherapy; stereotactic body radiation therapy; transarterial chemoembolization refractory.