Comparable Clinical Outcomes Between Transarterial Chemoembolization or Hepatic Arterial Infusion Chemotherapy Combined with Tyrosine Kinase Inhibitors and PD-1 Inhibitors in Unresectable Hepatocellular Carcinoma

Teng Long; Zhoutian Yang; Huilan Zeng; Weijie Wu; Zhiwen Hu; Zhenyun Yang; Dandan Hu; Zhongguo Zhou; Minshan Chen; Yaojun Zhang

doi:10.2147/JHC.S436211

Comparable Clinical Outcomes Between Transarterial Chemoembolization or Hepatic Arterial Infusion Chemotherapy Combined with Tyrosine Kinase Inhibitors and PD-1 Inhibitors in Unresectable Hepatocellular Carcinoma

J Hepatocell Carcinoma. 2023 Oct 20:10:1849-1859. doi: 10.2147/JHC.S436211. eCollection 2023.

Authors

Teng Long^#^{1

2}, Zhoutian Yang^#^{1

2}, Huilan Zeng^#^{1

2}, Weijie Wu^{1

2}, Zhiwen Hu^{1

2}, Zhenyun Yang^{1

2}, Dandan Hu^{1

2}, Zhongguo Zhou^{1

2}, Minshan Chen^{1

2}, Yaojun Zhang^{1

2}

Affiliations

¹ State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, 510060, People's Republic of China.
² Department of Liver Surgery, Sun Yat-sen University Cancer Center, Guangzhou, 510060, People's Republic of China.

^# Contributed equally.

Abstract

Purpose: To compare the treatment efficacy and safety of transarterial chemoembolization (TACE) or hepatic arterial infusion chemotherapy (HAIC) combined with tyrosine kinase inhibitors (TKIs) and programmed cell death protein-1 (PD-1) inhibitors for patients with unresectable hepatocellular carcinoma (HCC).

Patients and methods: 81 unresectable HCC patients were retrospectively analyzed, including 30 or 51 patients treated with either TKIs and PD-1 inhibitors combined with TACE (TTP) or HAIC (HTP), respectively. Tumor response and survival outcomes were compared.

Results: The median overall survival (mOS) was 21.0 months in the TTP group and 15.0 months in the HTP group (P = 0.525; HR = 1.23; 95% CI 0.66-2.29). The median progression-free survival (mPFS) was 6.7 months in the TTP group and 9.9 months in the HTP group (P = 0.160; HR = 0.70; 95% CI 0.42-1.16). After Propensity Score Matching (PSM), the mOS was 21.0 months in the TTP group and 18.0 months in the HTP group (P = 0.644; HR = 1.20; 95% CI 0.56-2.58). The mPFS was 6.4 months in the TTP group and 15.0 months in the HTP group (P = 0.028; HR = 0.49; 95% CI 0.26-0.93). The disease control rate in overall response (90.2% vs 76.7%, P = 0.116, before PSM; 91.7% vs 75.0%, P = 0.121, after PSM) and intrahepatic response (94.1% vs 80.0%, P = 0.070, before PSM; 91.7% vs 79.2%, P = 0.220, after PSM) were higher in the HTP group than in the TTP group.

Conclusion: Though including more advanced tumors, the clinical outcomes of HAIC combined with TKIs and PD-1 inhibitors are comparable to TACE-based combination therapy for unresectable HCC. Nevertheless, HTP significantly improved the PFS benefits in HCC patients with with large tumor burden or vascular invasion.

Keywords: hepatic arterial infusion chemotherapy; hepatocellular carcinoma; programmed cell death protein −1; transarterial chemoembolization; tyrosine kinase inhibitors.

Grants and funding

This work is funded by the National Natural Science Foundation of China (No. 82103566).