Combined iodine-125 seed strand, portal vein stent, transarterial chemoembolization, lenvatinib and anti-PD-1 antibodies therapy for hepatocellular carcinoma and Vp4 portal vein tumor thrombus: A propensity-score analysis

Zi-Han Zhang; Si-Nan Hou; Jia-Ze Yu; Wen Zhang; Jing-Qin Ma; Min-Jie Yang; Qing-Xin Liu; Ling-Xiao Liu; Jian-Jun Luo; Xu-Dong Qu; Zhi-Ping Yan

doi:10.3389/fonc.2022.1086095

Combined iodine-125 seed strand, portal vein stent, transarterial chemoembolization, lenvatinib and anti-PD-1 antibodies therapy for hepatocellular carcinoma and Vp4 portal vein tumor thrombus: A propensity-score analysis

Front Oncol. 2023 Jan 19:12:1086095. doi: 10.3389/fonc.2022.1086095. eCollection 2022.

Authors

Zi-Han Zhang^{1

2

3}, Si-Nan Hou^{1

2

3}, Jia-Ze Yu^{1

2

3}, Wen Zhang^{1

2

3}, Jing-Qin Ma^{1

2

3}, Min-Jie Yang^{1

2

3}, Qing-Xin Liu^{1

2

3}, Ling-Xiao Liu^{1

2

3}, Jian-Jun Luo^{1

2

3}, Xu-Dong Qu^{1

2

3}, Zhi-Ping Yan^{1

2

3}

Affiliations

¹ Department of Interveintional Radiology, Zhongshan hospital, Fudan, University, Shanghai, China.
² Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China.
³ National Clinical Research Center of Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.

Abstract

Objective: To evaluate the safety and efficacy of interventional therapy (iodine-125[¹²⁵I] seed strand and portal vein stent [PVS] implantation plus transarterial chemoembolization [TACE]) combined with systemic therapy (lenvatinib plus anti-PD-1 antibody) as first-line treatment for hepatocellular carcinoma (HCC) patients with Vp4 portal vein tumor thrombus (PVTT).

Patients and methods: From December 2018 to October 2021, 87 HCC patients with Vp4 PVTT were included in this single-center retrospective study. Forty-seven patients underwent interventional therapy combined with lenvatinib and anti-PD-1 antibody (group A), while 40 cases underwent interventional therapy combined with lenvatinib only (group B). Overall response rate (ORR), stent occlusion rates (SOR), median overall survival (OS), median progression-free survival (PFS) and median stent patency time (SPT) were compared between the 2 groups.

Results: The mean intended dose (r = 10 mm; z = 0; 240 days) was 64.9 ± 1.0 Gy and 64.5 ± 1.1 Gy in group A and B, respectively (p = 0.133). ORR and SOR were significantly different between group A and B (ORR, 55.3% vs 17.5%, p < 0.001; SOR, 12.8% vs 35.0%, p = 0.014). In the propensity-score matching (PSM) cohort, the median OS, median PFS and median SPT were significantly longer in group A compared with group B (32 PSM pairs; OS, 17.7 ± 1.7 vs 12.0 ± 0.8 months, p = 0.010; PFS, 17.0 ± 4.3 vs 8.0 ± 0.7 months, p < 0.001; SPT, not-reached vs 12.5 ± 1.1 months, p = 0.028).

Conclusion: This interventional therapy combined with lenvatinib and anti-PD-1 antibody is safe and effective for HCC patients with Vp4 PVTT.

Keywords: anti-PD-1 antibody; hepatocellular carcinoma; iodine-125 seed strand; lenvatinib; portal vein tumor thrombus; transarterial chemoembolization.

Grants and funding

This study has received funding from the project of Shanghai Municipal Heath Bureau (20194Y0154) and Natural Science Foundation of Shanghai (20ZR1452700).