Advancements in second-line treatment research for hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is one of the most common malignant tumors, characterized by high incidence and mortality rates. Due to its insidious onset, most patients are diagnosed at an advanced stage, often missing the opportunity for surgical resection. Consequently, systemic treatments play a pivotal role. In recent years, an increasing number of drugs have been approved for first-line systemic treatment of HCC. However, their efficacy is limited, and some patients develop drug resistance after a period of treatment. For such patients, there is currently a lack of standard second-line systemic treatment options. This review summarizes the latest advancements in second-line systemic treatment research for HCC patients who have developed resistance to various first-line systemic treatments, aiming to provide more rational and personalized second-line treatment strategies.

Protein profiling uncovers IGF-1R inhibition potential of 3-(2-furoyl)-indole scaffolds in hepatocellular carcinoma

AIM

This study investigates the anti-proliferative potential and possible molecular mechanisms of 3-(2-furoyl)-indole derivatives against HepG2.

METHOD

Identified hit compounds (4a, 4b, 4c) using MTT screening, were further investigated for their efficacy and mechanism of action through FACS studies, in-silico molecular docking, molecular dynamics (MD) simulations, and label-free quantitative proteome and ADMET prediction.

RESULTS

Lead compound 4a, showed IC50 of 27 µM against HepG2 cells and a binding score of -8.077 kcal/mol against IGF-1 R (PDB ID: 5XFS) and formed a stable complex 100 ns. Proteomic study revealed significant downregulation of the IGF-1 R downstream signaling molecules and showed minimal toxicity and favorable drug-like properties.

CONCLUSION

These findings suggest that 4a is a promising IGF-1 R inhibitor and potential drug candidate against drug resistance hepatocellular carcinoma (HCC).

Phase II study with sorafenib plus radiotherapy for advanced HCC with portal and/or hepatic vein tumor thrombosis

BACKGROUND & AIMS

Portal and hepatic vein tumor thrombosis is associated with inferior outcomes in patients with hepatocellular carcinoma (HCC), and systemic treatment alone is often insufficient. This phase II trial evaluated the efficacy and safety of combining sorafenib with radiotherapy in advanced HCC with thrombosis.

METHODS

Registered at ClinicalTrials.gov (NCT03535259), this phase II single-arm prospective trial targeted patients with HCC with portal or hepatic vein tumor thrombosis, liver minus gross tumor volume >700 ml, and Eastern Cooperative Oncology Group Performance Status scores of 0 or 1. Participants underwent 40-66 Gy radiotherapy for the hepatic primary tumor and vein tumor thrombosis, with concurrent oral sorafenib (400 mg twice daily) until disease progression or unacceptable adverse events. The primary endpoint was median overall survival (mOS) and the secondary endpoints included overall response rate (ORR) per Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 and Modified Response Evaluation Criteria in Solid Tumors (mRECIST), median progression-free survival (mPFS), time to tumor progression (TTP), tumor thrombosis control, and grade ≥3 adverse events.

RESULTS

Between May 2018 and January 2020, 86 patients were enrolled with a median radiotherapy dose of 54 Gy (40-65 Gy). At a median follow-up of 17.2 months, mOS, mPFS, and TTP stood at 16.5, 6.1, and 6.8 months, respectively. ORR reached 47.7% and 52.3% per RECIST and mRECIST, respectively. For the tumor thrombosis, 2-year control rates per mRECIST were 93.1%. No grade 5 adverse events were noted, whereas thrombocytopenia (22.1%) and leukopenia (14.0%) were the main grade 3 adverse events.

CONCLUSIONS

Concurrent sorafenib and radiotherapy is an effective and well-tolerated treatment for patients with HCC with portal or hepatic vein tumor thrombosis.

IMPACT AND IMPLICATIONS

Treatment options for patients with hepatocellular carcinoma (HCC) and vascular tumor thrombus are limited. The efficacy and safety of concurrent sorafenib and radiation for HCC with portal or hepatic vein tumor thrombosis has not been elucidated. This phase II trial shows that concurrent sorafenib and radiotherapy is effective and well-tolerated in the treatment of advanced HCC with portal vein or hepatic vein tumor thrombosis.

CLINICAL TRIALS REGISTRATION

This study is registered at ClinicalTrials.gov (NCT03535259).

Efficacy of radiotherapy combined with hepatic arterial infusion chemotherapy, TKI and ICI for hepatocellular carcinoma with portal vein tumor thrombus: a retrospective cohort study

PURPOSE

This retrospective study was conducted to evaluate the effectiveness and safety of a new combination therapy of radiotherapy (RT), hepatic arterial infusion chemotherapy (HAIC), tyrosine kinase inhibitors (TKI) and immune checkpoint inhibitors (ICI) for hepatocellular carcinoma (HCC) patients involving portal vein tumor thrombus (PVTT).

METHODS

A total of 71 HCC patients with PVTT were retrospectively analyzed: 45 patients were treated by 'HAIC + TKI + ICI' therapy and 26 patients by the new combination therapy. The primary outcomes were overall survival (OS), progression-free survival (PFS), and cumulative survival rate.

RESULTS

The PFS in the 'New combination therapy' group was longer than that in the 'HAIC + TKI + ICI' group (HR 0.459, 95%CI 0.253-0.832; P = 0.008). Meanwhile, the OS in the 'New combination therapy' group was also longer than that in the 'HAIC + TKI + ICI' group (HR 0.420, 95%CI 0.198-0.894; P = 0.024). Compared with 'HAIC + TKI + ICI' group patients, the 'New combination therapy' group patients had higher 1-year PFS rate and 1-year OS rate (P = 0.029; P = 0.015). There was no significant difference in the incidence of adverse events between the two groups.

CONCLUSION

The new combination therapy was an effective and safe non-surgical treatment for HCC patients with PVTT and could be considered a preferred therapy option.

Establishment of a prognosis-related predictive model for hepatocellular carcinoma patients with macrovascular invasion treated with transcatheter arterial chemoembolization combined with intensity modulated radiotherapy

Background

So far, there are still few studies on the prognostic factors of hepatocellular carcinoma (HCC) patients with macrovascular invasion (MVI) treated with transcatheter arterial chemoembolization (TACE) combined with intensity modulated radiotherapy (IMRT), and no relevant model has been established to predict the prognosis of such patients. Thus, the purpose of this study was to determine the prognostic factors of HCC patients with MVI after treatment with TACE combined with IMRT, and to establish a nomogram model for forecasting 1-, 3-, 5-year overall survival (OS) of the patients.

Methods

HCC patients with MVI who were diagnosed and treated at Department of Gastroenterology, 3201 Hospital between January 2010 and December 2020 were enrolled in this study according to the inclusion and exclusion criteria. The risk factors linked to patient OS were determined by performing Cox regression analysis. The nomogram for predicting 1-, 3-, 5-year OS in HCC patients with MVI was stablished and validated based on the results of the Cox regression analysis.

Results

In total, 118 patients were included in the current study. The medium follow-up time was 46 months (range, 29-71 months). Univariate Cox regression analysis revealed that tumor diameter, treatment frequency of TACE, IMRT dose, Child-Pugh grade, liver cirrhosis and alpha fetoprotein (AFP) level were significantly related to the OS of the patients. Further multivariate Cox regression analysis showed that treatment frequency of TACE and Child-Pugh grade, liver cirrhosis and AFP level were the independent prognostic factors of the OS in patients who were treated with TACE combined with IMRT. The nomogram we constructed using the above independent risk factors exhibited good ability for predicting 1-, 3-, 5-year OS of the patients. The concordance-index of the nomogram was 0.727, indicating the nomogram had a good discrimination.

Conclusions

Treatment frequency of TACE and Child-Pugh grade, liver cirrhosis and AFP level were independent predictors of OS in HCC patients with MVI after TACE combined with IMRT treatment. The nomogram that we developed using these predictors provided a convenient tool to predict the survival probability in HCC patients with MVI.

Increment of Skeletal Muscle Mass Predicts Survival Benefit for Hepatocellular Carcinoma Treated with Transarterial Chemoembolization Combining Molecular Targeted Agents and Immune Checkpoint Inhibitors

Purpose

To assess the relationship between clinical prognosis and changes of skeletal muscle mass for unresectable hepatocellular carcinoma (uHCC) patients who received transarterial chemoembolization (TACE) with molecular-targeted agents and immune checkpoint inhibitors (TACE-MTAs-ICIs).

Methods

From June 2019 to June 2023, a total of 92 uHCC patients who received TACE-MTAs-ICIs therapy were included. Skeletal muscle mass was assessed before and 6 months after treatment. Skeletal muscle index (SMI) is calculated as skeletal muscle area at the L3 vertebra divided by the square of height, then the change rate of SMI (ΔSMI) is calculated. Patients were stratified based on ΔSMI as muscle gain and non-muscle gain groups. Overall survival (OS) was compared between groups and prognostic factors for OS were analyzed. Progression-free survival (PFS) was also recorded.

Results

The median OS in the muscle gain group was significantly longer than that in the non-muscle gain group (Not reach vs 25.2 months, P < 0.001). The median PFS did not reach significant between two groups (16.2 vs 9.1 months, P = 0.101). Multivariate analyses revealed that skeletal muscle gain (HR = 0.20; 95% CI, 0.06-0.68; P = 0.010) and Barcelona Clinic Liver Cancer stage (HR = 1.94; 95% CI, 1.02-3.69; P = 0.044) were independent prognostic factors for OS.

Conclusion

SMI increment appeared as a favorable predictor for these uHCC patients who received TACE-MTAs-ICIs therapy.

Long-Term Outcomes of Transarterial Chemoembolization plus Ablation versus Surgical Resection in Patients with Large BCLC Stage A/B HCC

RATIONALE AND OBJECTIVES

Large hepatocellular carcinoma (HCC) exhibits heterogeneous morphologies and varied responses to treatment. We evaluated outcomes of patients with different large HCC classifications receiving surgical resection (SR) or transarterial chemoembolization plus ablation (TA).

MATERIALS AND METHODS

Patients with HCC ≥ 5 cm receiving SR or TA between May 2016 and December 2020 at one center were analyzed retrospectively and with propensity score matching (PSM). Overall survival (OS) and progression-free survival (PFS) of the 2 treatment groups were compared. Tumors were classified according to imaging morphology and gross pathology: Type I, simple nodular; Type II, simple nodular with extranodular growth or confluent multinodular; Type III, infiltrative.

RESULTS

Of 644 patients, 374 met the inclusion criteria (300 received SR and 74 received TA). Before PSM, median follow-up was 51.2 (IQR 29.6-65.3) months, and the SR group had longer OS (HR 2.13, 95% CI 1.44-3.15, p<0.001) and PFS (HR 2.31, 95% CI 1.66-3.20, p<0.001) than the TA group; after PSM these differences were not significant (all p>0.05). Infiltrative HCC (Type III) was an independent negative prognostic factor for OS and PFS. Within both treatment groups, patients with infiltrative HCC had shorter OS and PFS than patients with non-infiltrative HCC (Types I and II) (all p<0.001).

CONCLUSION

For patients with HCC ≥ 5 cm, tumor classification is an important prognostic factor. In patients with non-infiltrative HCC, TA and SR had comparable OS after PSM. For patients with infiltrative HCC, TA and SR had limited efficacy.

Development of Cytolytic Iridium-Complexed Octaarginine Peptide Albumin Nanomedicine for Hepatocellular Carcinoma Treatment

Objective

Hepatocellular carcinoma is one of the most challenging malignancies and has high incidence and mortality rates worldwide. Digital subtraction angiography (DSA)-guided hepatic arterial infusion of the standard chemotherapeutic agent oxaliplatin (OXA) has the advantages of both precision and efficacy, making it an important therapeutic strategy for advanced-stage liver cancer. However, patients receiving this treatment still face severe systemic toxicity and poor tolerability of oxaliplatin.

Methods

In this study, we compared oxaliplatin with novel albumin-formulated oncolytic peptide nanoparticles, Ir-cR8 (abbreviated as iPep), in the treatment of orthotopic liver cancer in a mouse model by intravenous injection and in a rabbit model via DSA-guided hepatic arterial infusion.

Results

The results showed that intravenous Ir-cR8-BSA-NPs had enhanced inhibitory effects to the growth of H22 ectopic liver tumors in mice and also with reduced toxicity in animals compared to OXA treatment. Specifically, Ir-cR8-BSA-NPs-treated mice showed approximately 92% tumor growth inhibition compared to approximately 88% for OXA. In the rabbit VX2 ectopic hepatocellular carcinoma model, Ir-cR8-BSA-NPs demonstrated significantly stronger inhibition (P<0.01) of tumor size compared to OXA, as assessed by PET/CT imaging, with SUV values decreasing from 5.15±0.46 to 2.52±0.57, compared to OXA-treated group, which decreased from 5.44±0.43 to 3.90±0.24. Furthermore, Ir-cR8- BSA-NPs significantly improved stability by albumin encapsulation and reduced hemolytic toxicity (P<0.001), resulting in improved therapeutic efficacy.

Conclusion

This study demonstrated the combined advantages of a novel membrane-active oncolytic peptide nanomedicine and precise drug delivery enabled by arterial infusion technology for the interventional treatment of liver cancer.

Enhanced efficacy of immune checkpoint inhibitors combined locoregional therapy and tyrosine kinase inhibitors in the treatment of unresectable hepatocellular carcinoma: A single - center retrospective study

Background

Unresectable hepatocellular carcinoma (HCC) presents significant treatment challenges. While locoregional therapies (LT) and tyrosine kinase inhibitors (TKI) offer some benefits, prognosis remains poor. Immune checkpoint inhibitors (ICI) have shown promise in other oncological settings, suggesting potential benefits in HCC treatment regimens.

Methods

This retrospective study analyzed 232 patients diagnosed with unresectable HCC at West China Hospital from January 2019 to December 2023. Patients were categorized into two treatment groups: LT+TKI and LT+TKI+ICI. All patients underwent standardized locoregional treatments and first-line TKIs, with the latter group also receiving ICIs. The primary endpoints measured were overall survival (OS) and progression-free survival (PFS). Survival analysis utilized Kaplan-Meier estimates and Cox regression models.

Results

The LT+TKI+ICI group demonstrated significantly improved survival outcomes compared to the LT+TKI group. Median OS was 28 ± 3.9 months in the LT+TKI+ICI group versus 21 ± 3.0 months in the LT+TKI group, with corresponding 6-, 12-, and 24-month OS rates of 96.8%, 79.3%, and 59.4% versus 85.8%, 71.5%, and 44.1%, respectively (HR, 0.64; 95% CI, 0.449-0.913; P = 0.014). Median PFS also favored the LT+TKI+ICI group (11 ± 1.1 months vs. 7 ± 0.76 months; HR, 0.60; 95% CI, 0.452-0.805; P<0.001). Multivariable analysis identified LT+TKI, vascular invasion, and metastasis as independent risk factors for poorer survival outcomes.

Conclusions

Adding ICI to LT and TKI significantly extends both OS and PFS in patients with unresectable HCC. These findings suggest that integrating ICI into treatment protocols could be beneficial in managing unresectable HCC, particularly for patients with vascular invasion.

Discovery of primary lung cancer following resection of rectal cancer lung metastasis: A case report

BACKGROUND

Colorectal cancer (CRC) ranks high among the most common types of malignant tumors. The primary cause of cancer-related mortality is metastasis, with lung metastases accounting for 32.9% of all cases of metastatic CRC (MCRC). However, cases of MCRC in the lungs, which present concurrently with primary peripheral lung adenocarcinoma, are exceptionally rare.

CASE SUMMARY

This report describes the case of a 52-year-old female patient who, following a colonoscopy, was diagnosed with moderately differentiated adenocarcinoma based on rectal mucosal biopsy findings. A preoperative chest computed tomography scan revealed a ground-glass nodule in the right lung and a small nodule (approximately 0.6 cm in diameter) in the extramural basal segment of the left lower lobe, which suggested multiple lung metastases from rectal cancer. Subsequent treatment and follow-up led to a diagnosis of rectal cancer with left lung metastasis and peripheral adenocarcinoma of the lower lobe of the right lung.

CONCLUSION

This case report describes the therapeutic journey of a patient with lung metastasis from rectal cancer in addition to primary peripheral adenocarcinoma, thus underscoring the critical roles of multidisciplinary collaboration, personalized treatment strategies, and comprehensive patient rehabilitation guidance.

Transarterial chemoembolization in hepatocellular carcinoma: exploring its role in vascular invasion and extrahepatic metastasis: A systematic review

BACKGROUND AND AIMS

Transarterial chemoembolization (TACE) is a significant intervention in hepatocellular carcinoma (HCC) management, but controversies persist regarding its application in advanced cases with vascular invasion or extrahepatic metastasis. This systematic review aims to explore TACE's efficacy and safety in these cases.

METHODS

A literature search was conducted on TACE in HCC patients with vascular invasion or extrahepatic metastasis. The study compared TACE with surgical resection/chemotherapeutic drugs or with no group as well. Safety was assessed for adverse outcomes and efficacy, including overall survival, mean survival, and progression-free survival (PFS). Data extraction included study characteristics, patient demographics, intervention details, outcomes, and adverse events.

RESULTS

A study of 28 studies involving 3740 patients found that TACE showed diverse safety and efficacy outcomes. Safety evaluations focused on liver function tests, while patient-reported symptoms included fever, pain, vomiting, and gastrointestinal issues. Overall survival was under 10 months in 9 studies, with PFS lower in the TACE group compared to conservative treatments. Survival rates ranged from 93.4% at 3 months to 13% at 24 months across studies. The study identified potential subsets where TACE exhibited efficacy, especially in cases with favorable liver function or specific tumor classifications.

CONCLUSION

Our findings suggest a potential role for TACE in certain subsets of advanced HCC patients. Tailored treatment algorithms, informed by rigorous clinical trials and considering various prognostic factors, hold the potential to enhance the management and outcomes for this complex patient population.

Effectiveness and safety of transarterial chemoembolization combined with PD-1 inhibitors and lenvatinib for unresectable intrahepatic cholangiocarcinoma

BACKGROUND

The objective of this study was to evaluate the therapeutic effectiveness and safety of transarterial chemoembolization (TACE) combined with programmed cell death-1 (PD-1) inhibitors and lenvatinib in the treatment of unresectable intrahepatic cholangiocarcinoma (uICC).

METHODS

This multicenter retrospective study screened patients with uICC who underwent TACE in combination with PD-1 inhibitors and lenvatinib between January 2019 and June 2023. Tislelizumab or camrelizumab (200 mg) was intravenously administered every three weeks. The daily dose of lenvatinib was 8 mg for patients weighing < 60 kg and 12 mg for those weighing ≥ 60 kg. In cases of disease progression, the therapeutic strategy was adjusted based on the clinical condition and individual patient's treatment preferences. Options included transitioning to standard or supportive care or continuing treatment with TACE in combination with PD-1 inhibitors and lenvatinib. The primary outcomes were overall survival (OS) and progression-free survival (PFS), while secondary outcomes included the objective response rate (ORR), disease control rate (DCR), and the incidence of adverse events (AEs).

RESULTS

A total of 59 patients with uICC were included. Over a median follow-up period of 32.3 months, the median OS and PFS were 25.8 months (95% confidence interval [CI]: 17.9-33.7) and 9.5 months (95% CI: 7.9-11.0), respectively. The ORR was 55.9%, and the DCR was 96.6%. Grade 3 or four AEs were observed in 15 of 59 patients (25.4%).

CONCLUSION

TACE combined with PD-1 inhibitors and lenvatinib demonstrated a promising therapeutic potential with a manageable safety profile for patients with uICC.

RELEVANCE STATEMENT

The combination of TACE, PD-1 inhibitors, and lenvatinib represents a novel therapeutic option for patients with uICC.

KEY POINTS

TACE plus PD-1 inhibitors and lenvatinib represent a promising therapeutic strategy for uICC. The safety profile of TACE plus PD-1 inhibitors and lenvatinib was manageable. This study demonstrated improved outcomes compared to prior standard-of-care treatments.

Comprehensive Analysis of the Role of Heat Shock Proteins in the Immune Microenvironment and Clinical Significance of Hepatocellular Carcinoma

Purpose

Hepatocellular carcinoma (HCC) is a prevalent malignancy that not only imposes a substantial financial burden but also significantly impacts the quality of life and overall survival of affected individuals. Heat shock proteins (HSPs) are a protein class with significant involvement in safeguarding and restoring cellular integrity. They help restore proper protein structure by binding to and refolding denatured proteins. However, the specific role of HSPs in HCC requires further investigation.

Methods

We analyzed the genomic characteristics of HSPs in liver cancer in the TCGA and ICGC databases, and functional enriched analysis of HSPs. Construction of an HSPs-Related Prognostic Model for patients with hepatocellular carcinoma. HSP-related risk score (HRRS) was identified as an independent prognostic factor in patients with hepatocellular carcinoma, and the clinical pathological characteristics and immune microenvironment of high-risk and low-risk groups were compared. Further, we studied HRRS-based liver cancer treatment strategies and confirmed the protein expression of HSPD1 and DNAJC5 in normal liver tissues and hepatocellular carcinoma tissues by collecting human hepatocellular carcinoma tissues.

Results

We observed elevated expression levels of most HSPs across HCC tissues. In addition, 14 hSPs were found to be related to prognostic significance among HCC patients and utilized to develop HRRS prognostic model for prognosis prediction and risk stratification. The prognostic and immunotherapeutic response predictive value of HRRS was validated utilizing data from TCGA and GEO cohorts. Moreover, we created a nomogram to assess HRRS clinical utility and verified its efficiency through various methods. Through IHC was found that HSPD1 and DNAJC5 were significantly overexpressed in hepatocellular carcinoma tissues.

Conclusion

Our results lead us to conclude that HCC's development and progression are intimately associated with HSPs, and the HRRS model represents a potentially robust prognostic model that could assist in clinical decision-making regarding chemotherapy and immunotherapy for HCC patients. Moreover, HSPD1 and DNAJC5 have the potential to serve as therapeutic targets for HCC.

Hepatic artery infusion chemotherapy: A resurgence

In this manuscript, we comment on the article by Zhou et al, who assessed the efficacy of hepatic arterial infusion chemotherapy (HAIC) and its combination strategies for advanced hepatocellular carcinoma (HCC) using network meta-analysis methodology. We focus specifically on the potential advantages and role of HAIC in the treatment algorithm for advanced HCC. However, there remains numerous knowledge gaps before the role of HAIC can be established. There is significant heterogeneity of HAIC regimes with difficult interpretation of the clinical outcomes. Additionally, there is a lack of direct comparative data between HAIC, systemic chemotherapy, novel immunotherapies and targeted therapies. The underlying biochemical mechanisms that might explain the efficacy of HAIC and its effect on the HCC microenvironment requires further research. In the developing era of nanotechnology and targeted drug delivery systems, there is potential for integration of HAIC with novel technologies to effectively treat advanced HCC whilst minimising systemic complications.

Key prognostic factors in transarterial chemoembolization combined with sorafenib treatment for hepatocellular carcinoma with portal vein tumor thrombosis

BACKGROUND

Hepatocellular carcinoma (HCC) is a prevalent malignancy worldwide, with portal vein tumor thrombosis (PVTT) worsening its prognosis and complicating management. The combination of transarterial chemoembolization (TACE) and the targeted agent sorafenib has been proposed to improve treatment outcomes. This study investigates the prognostic factors influencing the effectiveness of this combined treatment in HCC patients with PVTT.

METHODS

A retrospective cohort study was conducted on 299 patients diagnosed with HCC and PVTT who underwent TACE and sorafenib treatment between January 2018 and December 2022. Patients were categorized into good-prognosis (n = 197) and poor-prognosis (n = 102) groups based on Response Evaluation Criteria in Solid Tumors (RECIST) assessed four weeks post-treatment. Prognostic factors were analyzed using univariate and multivariate analyses to identify significant determinants affecting therapeutic outcomes.

RESULTS

Key prognostic factors included tumor number, differentiation, size, PVTT extent, Child-Pugh class, ECOG performance status, hospitalization duration, and AFP levels. Patients with a single tumor had better outcomes (OR 0.358, P = 0.002), whereas poor differentiation (OR 4.561, P = 0.005) and larger tumor size (OR 0.347, P < 0.001) were associated with worse prognosis. A higher Child-Pugh class (OR 0.563, P = 0.035) and better ECOG performance (OR 2.710, P = 0.025) improved prognosis, while prolonged hospitalization and elevated AFP levels were linked to poorer outcomes. ASA classification and HCC morphology did not significantly impact prognosis.

CONCLUSION

The prognosis of HCC with PVTT treated with TACE and sorafenib is significantly influenced by tumor characteristics, liver function, and overall patient health. Identifying these factors can aid in refining personalized treatment strategies to improve survival outcomes.

Efficacy of sorafenib combined with transarterial chemoembolization in the treatment of advanced hepatocellular carcinoma: A meta-analysis

BACKGROUND

The combination of sorafenib with transarterial chemoembolization (TACE) is being investigated for its potential to improve outcomes in advanced hepatocellular carcinoma (HCC).

AIM

To evaluate the efficacy of this combined treatment strategy in enhancing overall survival (OS) and progression-free survival (PFS) compared to monotherapies.

METHODS

A systematic review was conducted following the PRISMA guidelines. A comprehensive search was performed across PubMed, EMBASE, Web of Science, and the Cochrane Library up to May 8, 2024. Studies were included if they compared sorafenib plus TACE to sorafenib alone or TACE alone in adults with advanced HCC. Primary outcomes were OS, PFS, response rates, and safety profiles. Data extraction and quality assessment were independently performed by two reviewers. Heterogeneity was assessed using the I² statistic, and a random-effects model was applied for pooling data. Sensitivity analysis and publication bias assessment were also conducted.

RESULTS

A total of twelve studies involving 1174 patients met the inclusion criteria. Significant heterogeneity was observed for both OS (I² = 72.6%, P < 0.001) and PFS (I² = 83.7%, P < 0.001). The combined treatment of sorafenib with TACE significantly improved OS [hazard ratio (HR) = 0.60, 95% confidence interval (CI): 0.44-0.76] and PFS (HR = 0.54, 95%CI: 0.38-0.69). Sensitivity analysis confirmed the robustness of these findings. Funnel plots and Egger's test indicated no significant publication bias.

CONCLUSION

Sorafenib combined with TACE significantly enhances both OS and PFS in patients with advanced HCC compared to monotherapy. This combination therapy represents a promising approach to improving clinical outcomes in advanced liver cancer.

PD1+ Treg cell remodeling promotes immune homeostasis within peripheral blood and tumor microenvironment after microparticles-transarterial chemoembolization in hepatocellular carcinoma

The effects of transarterial chemoembolization (TACE) on the systemic immune in hepatocellular carcinoma (HCC) are not well understood. We aimed to reveal the temporal and spatial changes in the immune profile of peripheral blood and tumor tissues in HCC patients following TACE. Eighty-four HCC patients were included, 20 of whom received TACE with a median follow-up of 28 months. Immune cell proportion within peripheral blood was profiled with flow cytometry, and therapeutic efficacy was evaluated by imaging examinations. Additionally, cell distribution within tumor microenvironment (TME) were compared between the necrotic tumor infiltration zone (N-IZ) and the residual tumor infiltration zone (R-IZ) by multiplex immunofluorescence. Among 20 patients, 25% (5/20) achieved complete response, and 75% (15/20) showed partial response. Fourteen patients received combinational targeted therapy and immunotherapy and the median progression-free survival was 15.5 months. Compared to healthy individuals, HCC exhibited significantly higher proportions of regulatory T cells (Tregs) and programmed death-1 receptor (PD1)+ Tregs within peripheral blood. PD1+ Treg cells, PD1+ CD4+ T cells and PD1+ CD8+ T cells decreased significantly within peripheral blood after TACE. In TME, N-IZ showed significantly lower CD4+ T, CD8+ T and FOXP3+ Tregs, higher PD1+ CD8+/CD8+ and PD1+ CD8+/ PD1+ FOXP3+. Moreover, the spatial distance between CD8+ T cells and the nearest FOXP3+ Tregs in N-IZ was significantly greater than in R-IZ. Our findings demonstrated that TACE could both remodel the immune components in peripheral blood and TME, strengthening the rationale for developing immunotherapy alongside TACE.

Enhanced antitumor activity of combined hepatic arterial infusion chemotherapy with Lenvatinib and PD-1 inhibitors in unresectable hepatocellular carcinoma: a meta-analysis

Background

Hepatic arterial infusion chemotherapy (HAIC) is increasingly recognized as a primary treatment option for patients with unresectable hepatocellular carcinoma (uHCC), providing a focused treatment for localized tumors. The combination of lenvatinib, a multikinase inhibitor, with PD-1 inhibitors has demonstrated significant survival benefits in HCC. This meta-analysis aims to assess whether the integration of HAIC with lenvatinib and PD-1 inhibitors (referred to as the HAIC-L-P group) leads to better treatment effectiveness and security compared to lenvatinib and PD-1 inhibitors alone (L-P group) in uHCC.

Methods

An exhaustive search of the literature was conducted, including PubMed, the Cochrane Library, Embase, ClinicalTrials.gov, and Web of Science, from the start of each database until September 2024, to ensure a thorough and up-to-date compilation of relevant studies. Extract data on outcome measures such as overall survival (OS), progression-free survival (PFS), objective response rate (ORR), disease control rate (DCR), and adverse events (AEs). Subsequently, meta-analyses were performed using RevMan 5.4 to quantitatively evaluate the aggregated effect of the HAIC-L-P regimen versus the L-P regimen alone.

Results

In our systematic meta-analysis of eight retrospective cohort studies, the HAIC-L-P regimen demonstrated markedly enhanced OS, with an HR of 0.54 (95% CI: 0.45-0.64; p < 0.00001), and enhanced 1-year and 2-year OS rates. Superior PFS was also observed in the HAIC-L-P group, with an HR of 0.64 (95% CI: 0.55-0.75; p < 0.0001), and higher 1-year and 2-year PFS rates. Response rates were markedly higher in the HAIC-L-P group, with an ORR risk ratio of 2.15 (95% CI: 1.84-2.50; p < 0.00001) and a DCR risk ratio of 1.28 (95% CI: 1.20-1.43; p < 0.0001). The AEs classified as grade 3 or above were elevated in the HAIC-L-P group, with notable risk ratios for vomiting, elevated AST, elevated ALT, thrombocytopenia, neutropenia, and hyperbilirubinemia. No life-threatening AEs were reported.

Conclusion

The HAIC-L-P regimen correlated with enhanced tumor responses and prolonged survival, alongside manageable adverse effects, indicating its potential as a viable therapeutic strategy for individuals afflicted with uHCC.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024594109.

Combining immune checkpoint inhibitors and molecular-targeted agents with hepatic arterial infusion chemotherapy for hepatocellular carcinoma with inferior vena cava and/or right atrium tumor thrombus

BACKGROUND

Hepatocellular carcinoma with inferior vena cava and/or right atrium tumor thrombus (HCC-IVC/RATT) has a poor prognosis and lacks evidence for standard first-line systemic therapy. This study aims to evaluate the effectiveness and safety of three therapeutic regimens in HCC-IVC/RATT: immune checkpoint inhibitors plus molecular-targeted agents (ICI-MTA), hepatic arterial infusion chemotherapy (HAIC), and their combination (ICI-MTA-HAIC).

METHODS

This multicenter retrospective cohort study included consecutive HCC-IVC/RATT who received ICI-MTA-HAIC, ICI-MTA, or HAIC from June 2015 to December 2023. Propensity score matching (PSM) was used to balance baseline characteristics.

RESULTS

A total of 355 patients were included: 209 received ICI-MTA-HAIC, 66 received ICI-MTA, and 80 received HAIC. After PSM, the ICI-MTA-HAIC group showed superior median overall survival (OS) to both the ICI-MTA (18.0 vs. 7.5 months, p < 0.001) and HAIC (18.5 vs. 7.1 months, p < 0.001) groups. The ICI-MTA-HAIC group demonstrated better median progression-free survival (PFS) and objective response rate (ORR) compared to the ICI-MTA (PFS: 9.5 vs. 4.4 months; ORR: 47.0% vs. 21.3%, all p < 0.001) and HAIC (PFS: 9.5 vs. 4.4 months; ORR: 48.8% vs. 21.6%, all p < 0.001) groups. There was no significant difference in OS, PFS, or ORR between the ICI-MTA and HAIC groups (all p > 0.05). Grade 3-4 adverse event rates were 49.8%, 33.3%, and 35.0% for the ICI-MTA-HAIC, ICI-MTA, and HAIC groups, respectively. No unexpected events or treatment-related deaths were observed.

CONCLUSION

ICI-MTA-HAIC was a safe and effective therapy that prolonged the survival of HCC-IVC/RATT compared to ICI-MTA or HAIC.

Hepatocellular carcinoma: signaling pathways and therapeutic advances

Liver cancer represents a major global health concern, with projections indicating that the number of new cases could surpass 1 million annually by 2025. Hepatocellular carcinoma (HCC) constitutes around 90% of liver cancer cases and is primarily linked to factors incluidng aflatoxin, hepatitis B (HBV) and C (HCV), and metabolic disorders. There are no obvious symptoms in the early stage of HCC, which often leads to delays in diagnosis. Therefore, HCC patients usually present with tumors in advanced and incurable stages. Several signaling pathways are dis-regulated in HCC and cause uncontrolled cell propagation, metastasis, and recurrence of HCC. Beyond the frequently altered and therapeutically targeted receptor tyrosine kinase (RTK) pathways in HCC, pathways involved in cell differentiation, telomere regulation, epigenetic modification and stress response also provide therapeutic potential. Investigating the key signaling pathways and their inhibitors is pivotal for achieving therapeutic advancements in the management of HCC. At present, the primary therapeutic approaches for advanced HCC are tyrosine kinase inhibitors (TKI), immune checkpoint inhibitors (ICI), and combination regimens. New trials are investigating combination therapies involving ICIs and TKIs or anti-VEGF (endothelial growth factor) therapies, as well as combinations of two immunotherapy regimens. The outcomes of these trials are expected to revolutionize HCC management across all stages. Here, we provide here a comprehensive review of cellular signaling pathways, their therapeutic potential, evidence derived from late-stage clinical trials in HCC and discuss the concepts underlying earlier clinical trials, biomarker identification, and the development of more effective therapeutics for HCC.

Gastrointestinal side effects in hepatocellular carcinoma patients receiving transarterial chemoembolization: a meta-analysis of 81 studies and 9495 patients

Background

Transarterial chemoembolization (TACE) is a widely used treatment for hepatocellular carcinoma (HCC), combining targeted chemotherapy and embolization. While effective, TACE can be associated with significant gastrointestinal (GI) side effects, impacting a patient's quality of life.

Objectives

Quantify the prevalence of key GI complications (diarrhea, nausea, GI toxicity, abdominal pain) following TACE.

Design

Systematic review was performed following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, focusing on studies that reported side effects of TACE. Studies not involving cTACE or drug-eluting bead TACE (DEB-TACE), non-HCC studies, meta-analyses or systematic reviews, and inaccessible publications were excluded.

Data sources and methods

A PubMed search for clinical and randomized trials was conducted. Extracted data included study identifiers, demographics, TACE details, and GI side effect prevalences. The Mixed Methods Appraisal Tool assessed study quality and bias.

Results

The analysis included data from 81 studies with 121 individual study arms and 9495 patients. Diarrhea was reported in 38 studies, with a mean prevalence of 23.46% (2.5; 95% confidence interval (CI): 18.39-28.544) and a weighted prevalence of 23.5%. Nausea was most frequently reported, mentioned in 67 studies, with a mean prevalence of 34.66% (2.4; 95% CI: 29.89-39.44) and a weighted prevalence of 32.5%. Abdominal pain was reported in 59 studies, with the highest mean prevalence of 48.07% (2.9; 95% CI: 42.20-53.93) and a weighted prevalence of 46.1%. GI toxicity was reported in 32 studies, with a mean prevalence of 8.85% (1.4; 95% CI: 5.99-11.70) and a weighted prevalence of 9.9%. DEB-TACE generally led to slightly higher rates of nausea, diarrhea, abdominal pain, and GI toxicity compared to conventional TACE. The type of chemotherapy agent influenced prevalence of GI-side effects, with high prevalences observed for agents such as zinostatin and cisplatin.

Conclusion

This meta-analysis synthesizes current evidence on managing GI side effects in TACE. Standardizing reporting and developing effective management strategies are crucial to improving patient outcomes.

Overcoming immunotherapy resistance in gastric cancer: insights into mechanisms and emerging strategies

Gastric cancer (GC) remains a leading cause of cancer-related mortality worldwide, with limited treatment options in advanced stages. Immunotherapy, particularly immune checkpoint inhibitors (ICIs) targeting PD1/PD-L1, has emerged as a promising therapeutic approach. However, a significant proportion of patients exhibit primary or acquired resistance, limiting the overall efficacy of immunotherapy. This review provides a comprehensive analysis of the mechanisms underlying immunotherapy resistance in GC, including the role of the tumor immune microenvironment, dynamic PD-L1 expression, compensatory activation of other immune checkpoints, and tumor genomic instability. Furthermore, the review explores GC-specific factors such as molecular subtypes, unique immune evasion mechanisms, and the impact of Helicobacter pylori infection. We also discuss emerging strategies to overcome resistance, including combination therapies, novel immunotherapeutic approaches, and personalized treatment strategies based on tumor genomics and the immune microenvironment. By highlighting these key areas, this review aims to inform future research directions and clinical practice, ultimately improving outcomes for GC patients undergoing immunotherapy.

The Combination of D-TACE-HAIC, Lenvatinib, and PD-1 Inhibitors Shows Significant Clinical Efficacy in Patients with Unresectable Hepatocellular Carcinoma

Purpose

This study was developed to compare the efficacy of combined D-TACE-HAIC + lenvatinib + PD-1 inhibitor treatment to that of TACE + sorafenib treatment for patients with intermediate and advanced HCC.

Patients and Methods

Here, a retrospective analysis of patients with unresectable HCC who underwent transarterial chemoembolization (TACE) from March 2018 to March 2022 at the our hospital was conducted. In total, 60 patients underwent treatment with drug-eluting beads-TACE-hepatic arterial infusion chemotherapy (D-TACE-HAIC) combined with lenvatinib and PD-1 inhibitors (Group A), while 21 underwent combined TACE and sorafenib treatment (Group B).

Results

In this study cohort, the rate of surgical conversion in Group A was significantly higher than that in Group B (33.3% vs 9.5%). As per the Revised Evaluation Criteria for Clinical Efficacy in Solid Tumors (mRECIST) criteria, the objective remission rate in Group A was significantly higher than that in Group B (86.6% vs 33.4%). Group A also exhibited significantly higher rates of overall adverse events including hypertension, abdominal pain, leukopenia, thrombocytopenia, and hypoproteinemia as compared to Group B, although the incidence of hand-foot syndrome in Group A was significantly reduced as compared to Group B (13.3% vs 42.8%). The median progression-free and overall survival (PFS and OS) of patients in Group A were 13.2 and 28.8 months, with both being significantly higher than the corresponding intervals in Group B (5.7 and 10.8 months, respectively). Cox multivariate analyses identified combination D-TACE-HAIC + lenvatinib+ PD-1 inhibitor treatment as being independently associated with patient PFS and OS.

Conclusion

In summary, D-TACE-HAIC + lenvatinib + PD-1 inhibitor treatment exhibits a favorable safety profile, outperforming TACE + sorafenib treatment for unresectable HCC patients while improving overall rates of translational efficacy, increasing rates of surgical conversion, prolonging patient survival, and conferring long-term survival benefits.

A pelvis MR transformer-based deep learning model for predicting lung metastases risk in patients with rectal cancer

Objective

Accurate preoperative evaluation of rectal cancer lung metastases (RCLM) is critical for implementing precise medicine. While artificial intelligence (AI) methods have been successful in detecting liver and lymph node metastases using magnetic resonance (MR) images, research on lung metastases is still limited. Utilizing MR images to classify RCLM could potentially reduce ionizing radiation exposure and the costs associated with chest CT in patients without metastases. This study aims to develop and validate a transformer-based deep learning (DL) model based on pelvic MR images, integrated with clinical features, to predict RCLM.

Methods

A total of 819 patients with histologically confirmed rectal cancer who underwent preoperative pelvis MRI and carcinoembryonic antigen (CEA) tests were enrolled. Six state-of-the-art DL methods (Resnet18, EfficientNetb0, MobileNet, ShuffleNet, DenseNet, and our transformer-based model) were trained and tested on T2WI and DWI to predict RCLM. The predictive performance was assessed using the receiver operating characteristic (ROC) curve.

Results

Our transformer-based DL model achieved impressive results in the independent test set, with an AUC of 83.74% (95% CI, 72.60%-92.83%), a sensitivity of 80.00%, a specificity of 78.79%, and an accuracy of 79.01%. Specifically, for stage T4 and N2 rectal cancer cases, the model achieved AUCs of 96.67% (95% CI, 87.14%-100%, 93.33% sensitivity, 89.04% specificity, 94.74% accuracy), and 96.83% (95% CI, 88.67%-100%, 100% sensitivity, 83.33% specificity, 88.00% accuracy) respectively, in predicting RCLM. Our DL model showed a better predictive performance than other state-of-the-art DL methods.

Conclusion

The superior performance demonstrates the potential of our work for predicting RCLM, suggesting its potential assistance in personalized treatment and follow-up plans.

Immunotherapy improved the efficacy of TACE or TACE plus MTTs in HCC patients: A meta-analysis

BACKGROUND

Although several studies have compared the efficacy and safety of transarterial chemoembolization (TACE) without immune checkpoint inhibitors (ICIs) and TACE with ICIs, there is still a lack of meta-analysis.

METHODS

PubMed, Embase, Web of Science, and the Cochrane Library were searched until July 2023 for studies comparing the efficacy and safety of TACE without ICIs (TACE ± molecular targeted therapies [MTTs]) and TACE without ICIs (TACE ± MTTs + ICIs). Outcomes included overall survival (OS), progression-free survival (PFS), objective response rate (ORR), disease control rate (DCR), and adverse events (AEs).

RESULTS

A total of 20 studies involving 2587 HCC patients were included in the meta-analysis. Eighteen studies including 2116 patients looked at the difference in OS between TACE ± MTTs or TACE ± MTTs + ICIs. Compared with TACE ± MTTs, TACE ± MTTs + ICIs were associated with significantly improved OS (HR, 0.37; 95 % CI, 0.30-0.46). Thirteen studies including 1650 patients investigated the difference in PFS between TACE ± MTTs or TACE ± MTTs + ICIs. The outcome showed that TACE ± MTTs + ICIs were associated with longer PFS (HR, 0.50; 95 % CI, 0.41-0.61, P < 0.001). Eighteen studies including 1971 patients investigated the difference in tumor response (ORR and DCR) between TACE ± MTTs or TACE ± MTTs + ICIs. The outcomes indicated that TACE ± MTTs + ICIs bring higher ORR and DCR compared to TACE ± MTTs (ORR: OR, 2.39; 95 % CI, 1.97-2.89, P < 0.001; DCR: OR, 2.30; 95 % CI, 1.84-2.88). Moreover, to look at the direct impact of ICIs, we investigated the difference in OS, PFS, ORR, DCR, AEs, and severe AEs between TACE + tyrosine kinase inhibitors (TKIs) and TACE + TKIs + ICIs. The results indicated that the addition of ICIs provided longer OS, longer PFS, higher ORR, and higher DCR, but did not bring additional AEs and severe AEs.

CONCLUSION

Immune checkpoint inhibitors improved the efficacy of TACE or TACE plus MTTs and prolonged the survival of patients with hepatocellular carcinoma. Meanwhile, the addition of immune checkpoint inhibitors to the TACE + TKIs did not bring additional adverse events.

Circular RNA microarray expression profile and potential function of circDOCK1 in colorectal cancer

Introduction

Endoscopic tissue biopsy combined with histopathology is the gold standard for the diagnosis of colorectal cancer (CRC); however, the invasive nature of this procedure hinders its acceptance by patients. Therefore, there exists a critical need to identify novel markers facilitating early CRC detection and prognosis. Circular RNAs (circRNAs) hold promise as novel clinical diagnostic markers. This study aimed to investigate the impact of circDOCK1 on CRC metastasis and prognosis as well as its underlying molecular mechanisms.

Methods

We explored circRNA expression profiles in four pairs of CRC tissues and adjacent non-carcinoma tissues via microarray analysis. After Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG), and circRNA-miRNA network analyses, circDOCK1 was chosen for further investigation. We evaluated its clinical relevance in 80 CRC tissue pairs and adjacent controls, correlating circDOCK1 expression with clinical characteristics. Follow-up data from patient telephone interviews were analyzed for survival outcomes. Transfection efficiency was confirmed via qRT-PCR in HCT116 and SW480 colon cells, and the effects of circDOCK1 on cell proliferation, migration, and invasion were assessed.

Results

Microarray data revealed 149 significantly differentially expressed circRNAs, including 71 upregulated and 78 downregulated circRNAs, in CRC tissues. CircDOCK1 exhibited elevated expression in patients with CRC and emerged as an independent prognostic factor. Kaplan-Meier curve analysis suggested that circDOCK1 expression is an unfavorable prognostic factor in patients with CRC. In vivo experiments revealed that circDOCK1 overexpression enhanced the proliferation, migration, and invasion of CRC cells, with consistent results upon circDOCK1 downregulation.

Conclusion

These data indicate that circDOCK1 may play a role in promoting the proliferation, migration, and invasion of CRC cells, suggesting its potential as a CRC biomarker.

Real world study on combining local interventions with systemic therapy in unresectable hepatocellular carcinoma

Combining local interventions with tyrosine kinase inhibitors (TKIs) plus anti-PD-1 antibodies in a triple therapy has demonstrated remarkable anti-tumor efficacy and facilitated conversion resection in patients with initially unresectable hepatocellular carcinoma (HCC). However, the long-term survival outcomes remain largely unexplored. This study focused on a cohort of consecutive patients who underwent triple therapy for initially unresectable HCC at the authors' hospital between January 2020 and December 2022. Specifically, patients who exhibited a positive response to triple therapy and fulfilled the criteria for hepatectomy were selected for liver resection. Additionally, investigation assessed association between clinical factors and successful achievement of conversion resection, as well as postoperative recurrence. The study cohort comprised 79 patients, among whom 20 individuals (25.3%) underwent R0 resection subsequent to the initiation of triple therapy. Notably, patients without extrahepatic disease and those who exhibited a radiographic response to triple therapy were more likely to be eligible for curative resection. Importantly, hepatectomy independently associated with a favorable overall survival (HR, 0.388; 95% CI, 0.177-0.847; P = 0.017). Other independent risk factors related to overall survival contained extrahepatic metastasis (HR, 2.152; 95% CI, 1.076-4.302; P = 0.030), tumor number ≥ 4 (HR, 2.058; 95% CI, 1.001-4.234; P = 0.049) and radiological remission (HR, 0.233; 95% CI, 0.071-0.768; P = 0.017). For the 20 patients who underwent surgery, 12-month recurrence-free survival and overall survival rates were respectively 43.3% and 66.6%. The triple therapy demonstrated favorable prognostic outcomes and manageable safety profiles in patients with initially unresectable HCC.

N-glycosylation of ACTRIIB enhances protein stability leading to rapid cell proliferation and strong resistance to docetaxel in nasopharyngeal carcinoma

Nasopharyngeal carcinoma (NPC) is a malignant tumor predominantly influenced by Epstein-Barr virus infection and genetic factors. The transforming growth factor-beta (TGF-β) superfamily is implicated in various cellular processes, including tumorigenesis. This study aimed to detect the role of one TGF-β superfamily member activin receptor type IIB (ACTRIIB) in NPC. This study analyzed NPC datasets, including GSE12452, GSE102349, and GSE53819. ACTRIIB expression and N-glycosylation levels were assessed by western blot, real-time PCR, immunofluorescence, and immunohistochemistry in NPC cells and tissues. As indicated by the datasets, ACTRIIB was significantly upregulated in NPC tissues, and the up-regulation was associated with poor prognosis. This study confirmed the N-glycosylation of ACTRIIB primarily at the forty-second amino acid, an asparagine. The N-glycosylation of ACTRIIB promoted the localization of ACTRIIB to the cell membrane and prevented the degradation of the protein by lysosomes, through which ACTRIIB activated the downstream Smard1/2 to promote tumor cell proliferation and invasion. Inhibition of N-glycosylation or knockdown of ACTRIIB resulted in reduced cell proliferation and invasion and increased the cell sensitivity to docetaxel. In conclusion, N-glycosylation of ACTRIIB was a critical post-translational modification that enhanced protein stability and induced membrane localization, which facilitates the functions of ACTRIIB in cell proliferation and invasion in NPC. Inhibition of ACTRIIB N-glycosylation could potentially serve as a therapeutic strategy to improve the efficacy of chemotherapy in NPC.

Transarterial Embolization Using an Inorganic Phosphate Binder Modulates Immunity- and Angiogenesis-Related Factors in a Rat Model of Liver Cancer

PURPOSE

To determine how low inorganic phosphate stress (LIPS) induced by sevelamer particle transarterial embolization (S-TAE) affects immune regulation and angiogenesis in hepatocellular carcinoma.

MATERIAL AND METHODS

Transcatheter arterial embolization (TAE) using conventional ethiodized oil plus polyvinyl alcohol microspheres and S-TAE, which depletes intratumoral inorganic phosphate, were conducted on a McA-RH7777 orthotopic liver tumor model in rats, followed by the assessment of alterations in immunity-related and angiogenesis-related factors. The cells were cultured under hypoxic conditions and stimulated with LIPS to analyze the modulation of programmed cell death 1 ligand (PD-L1), vascular endothelial growth factor (VEGF)-α, and transforming growth factor-β1 expression using western blotting, quantitative real-time polymerase chain reaction, and immunofluorescence assays. Cell migratory capacity and angiogenesis were also evaluated.

RESULTS

TAE increased the expression of neoplastic PD-L1 and VEGF-α, and S-TAE downregulated the expression of PD-L1, VEGF-α, and transforming growth factor TGF-β1 and augmented the infiltration of CD8+ T cells, and thereby inhibited angiogenesis and activated anticancer immunity. In vitro, the study demonstrated that LIPS inhibited hypoxia-induced upregulation of PD-L1 expression and the hypoxia-inducible factor-1α/VEGF-α axis. Moreover, LIPS inhibited the tube formation ability of human umbilical vein endothelial cells and the migration ability and epithelial-mesenchymal transition process of cancer cells under hypoxic conditions.

CONCLUSIONS

S-TAE inhibited the expression of PD-L1 and VEGF-α, thereby activating antitumor immunity and suppressing tumor angiogenesis. The biology of tumors under LIPS suggests the potential therapeutic value of phosphate depletion using sevelamer for S-TAE.

Bifidobacterium animalis ssp. lactis BX-245-fermented milk alleviates tumor burden in mice with colorectal cancer

Colorectal cancer (CRC) arises from the accumulation of abnormal mutations in colorectal cells during prolonged inflammation. This study aimed to investigate the potential of probiotic fermented milk containing the probiotic strain, Bifidobacterium animalis ssp. lactis BX-245 (BX-245), in alleviating tumor burden in CRC mice induced by azoxymethane and dextran sodium sulfate. The study monitored changes in tumor size and number, gut microbiota, metabolomics, and inflammation levels before and after the intervention. Our findings indicate that intragastric administration of BX245-fermented milk effectively modulated the intratumor microbiota, as well as the gut microbiota and its metabolism. We also observed a decreased relative abundance of intratumor Akkermansia in the CRC mice, while the intratumor Parabacteroides exhibited a significant positive correlation with tumor number and weight. Moreover, administering BX245-fermented milk significantly reduced gut barrier permeability, alleviated gut barrier damage, and increased serum IL-2 and IFN-γ levels compared with the ordinary fermented milk group. Collectively, our data suggest that administering probiotic fermented milk containing specific functional strains such as BX245 could result in a reduction in tumor burden in CRC mice. Conversely, ordinary fermented milk did not show the same tumor-inhibiting effects. The current results are preliminary, and further confirmation is necessary to establish the causal relationship among probiotic milk, changes in gut microbiota, and disease alleviation.

HAIC plus lenvatinib and tislelizumab for advanced hepatocellular carcinoma with Vp4 portal vein invasion

BACKGROUND/OBJECTIVE

The treatment strategy for hepatocellular carcinoma (HCC) with Vp4 (main trunk) portal vein tumor thrombosis (PVTT) remains controversial due to the dismal prognosis. We aimed to investigate the efficacy and safety of hepatic arterial infusion chemotherapy (HAIC) plus lenvatinib and tislelizumab in these patients.

METHODS

This multicenter retrospective study included treatment-naive HCC patients with Vp4 PVTT from 2017 to 2022. They were treated with HAIC plus lenvatinib and tislelizumab (HLP group) or HAIC alone (HAIC group). Overall survival (OS), progression-free survival (PFS), objective response rate (ORR), and adverse events (AEs) were assessed. Propensity score matching (PSM) was performed to reduce bias.

RESULTS

In this study, 155 HCC patients with Vp4 PVTT were included, with 38 in the HLP group and 117 in the HAIC group, with 35 per group matched by PSM. The HLP group showed longer median OS (23.2 vs. 6.9 months; HR 0.333, p < 0.001) and PFS (6.6 vs. 2.4 months; HR 0.403, p = 0.002) than the HAIC group. Higher ORR for tumor (77.1% vs. 42.9%, p = 0.003) and PVTT (51.4% vs. 22.9%, p = 0.025) was observed in the HLP group. More patients underwent hepatectomy post-conversion therapy (15.8% vs. 0.9%). Grade 3/4 AEs were higher in the HLP group (47.4% vs. 35.0%), but there was no significant difference, and no grade 5 AEs occurred in either group.

CONCLUSIONS

HAIC combined with lenvatinib and tislelizumab may be a promising treatment in patients with HCC and Vp4 PVTT because of the improved prognosis and acceptable safety profile.

Clinical value of circulating tumour cells in evaluating the efficacy of continuous hepatic arterial infusion among colorectal cancer patients

Few studies have been conducted to evaluate the efficacy of HAIC using circulating tumour cells (CTCs). In this study, a total of 100 patients who received HAIC treatment and CTC detection were selected. The results showed that after HAIC treatment, the levels of CTC, carbohydrate antigen 19-9 (CA19-9) and carcinoembryonic antigen (CEA) decreased. Postoperative progression-free survival (PFS) rates between patients with positive and negative preoperative CTC results, and for CA19-9, CEA were significantly different. The positive rate of CTCs was 61% before chemotherapy and 23% after chemotherapy, and the correlation coefficient between the two was 0.385. Those whose CTC values increased after chemotherapy had shorter PFS rates. CTCs are an independent predictor of recurrence. Patients with CTC-positive results are more susceptible to recurrence. The CTC count in peripheral blood has a close bearing on the postoperative chemotherapy efficacy of patients with CRC and affects patients' PFS.

Hepatic Arterial Infusion Chemotherapy Enhances the Efficacy of Lenvatinib Plus PD-1 Inhibitors in Hepatocellular Carcinoma Patients with Tumor Thrombosis in the Inferior Vena Cava and/or Right Atrium

RATIONALE AND OBJECTIVES

Hepatocellular carcinoma (HCC) with invasion into the inferior vena cava (IVC) or the right atrium (RA) presents significant therapeutic challenges due to its rapid progression and limited available treatments.

MATERIALS AND METHODS

This retrospective study evaluated the effectiveness of hepatic arterial infusion chemotherapy alongside lenvatinib and PD-1 inhibitors (HAIC-Len-PD1) compared to treatment with only lenvatinib and PD-1 inhibitors (Len-PD1). A total of 115 patients with HCC and IVC or RA invasion were included. We analyzed groups for median overall survival (OS) and progression-free survival (PFS) through the Kaplan-Meier method, along with tumor response rates, disease control rates, and adverse event frequencies.

RESULTS

The HAIC-Len-PD1 treatment showed a marked improvement in median OS (22.2 vs. 14.4 months; P = 0.007) and median PFS (13.8 vs. 5.1 months; P = 0.001) over the Len-PD1 regimen. There was also a higher overall response rate (68.7% vs. 37.5%; P < 0.05) and disease control rate (92.5% vs. 75%; P < 0.05) observed in the HAIC-Len-PD1 group. A subgroup analysis demonstrated consistent survival benefits across diverse patient demographics. Although the incidence of adverse events was higher in the HAIC-Len-PD1 group, these were generally manageable and well-tolerated.

CONCLUSION

The combined regimen of HAIC, lenvatinib, and PD-1 inhibitors may improve survival and tumor management in HCC patients with IVC or RA invasion, suggesting a potential therapeutic option for this critically at-risk group. Further research in the form of randomized controlled trials are needed to verify these findings for advanced-stage HCC with vascular compromise.

MRI-Based Radiomics Features for Prediction of Pathological Deterioration Upgrading in Rectal Tumor

PURPOSE

Our aim is to develop and validate an MRI-based diagnostic model for predicting pathological deterioration upgrading in rectal tumor.

METHODS

This retrospective study included 158 eligible patients from January 2017 to November 2023. The patients were divided into a training group (n = 110) and a validation group (n = 48). Radiomics features were extracted from T2-weighted images to create a radiomics score model. Significant factors identified through multifactor analysis were used to develop the final clinical feature model. By combining these two models, an combined radiomics-clinical model was established. The model's performance was evaluated using Receiver Operating Characteristic (ROC) analysis and the Area Under the ROC Curve (AUC).

RESULTS

A total of 1197 features were extracted, with 11 features selected for calculating the radiomics score to establish the radiomics model. This model demonstrated good predictive performance for pathological upgrading in both the training and validation groups (AUC of 0.863 and 0.861, respectively). Clinical factors such as chief complaint and differential carcinoembryonic antigen levels showed statistical significance (P < 0.05). The clinical model, incorporating these factors, yielded AUC values of 0.669 and 0.651 for the training and validation groups, respectively. Furthermore, the radiomics-clinical combined model outperformed the individual models in predicting preoperative pathological upgrading in both the training and validation groups (AUC of 0.932 and 0.907, respectively).

CONCLUSIONS

A radiomics-clinical model, which combines clinical features with radiomics features based on MRI, can predict pathological deterioration upgrading in patients with rectal tumor and provide valuable insights for personalized treatment strategies.

Colonization of stenotrophomonas and its associated microbiome between paired primary colorectal cancers and their lung metastatic tumors (experimental studies)

The role of gut microbiome in colorectal cancer (CRC) lung metastases is still unclear. Herein, we collected primary colorectal tumors, matched lung metastasis, and adjacent normal colon from seven patients for 16S rRNA sequencing to evaluate microbiome signature in distant site metastasis and analyze prognosis. Fecal samples from 19 non-metastases CRC patients and 11 CRC lung metastases patients were analyzed for validation. Our efforts led to a discovery of comprehensive microbiome in CRC lung metastatic tumors, characterized by a decreased microbial diversity and an increase bacterial interaction between gram-negative bacteria Stenotrophomonas and Brevundimonas . The primary-metastatic tumor pairs harbored highly similar microbial composition in both genus and species level, especially the high level of Stenotrophomonas maltophilia . Correspondingly, the S. maltophilia levels were positively associated with poor prognosis and cancer progression. Our work highlights the great potential of S. maltophilia and its associated microbiome as biomarkers in pathogenesis and prognosis of CRC lung metastases.

Arginine-Loaded Nano-Calcium-Phosphate-Stabilized Lipiodol Pickering Emulsions Potentiates Transarterial Embolization-Immunotherapy

Transarterial chemoembolization (TACE) continues to stand as a primary option for treating unresectable hepatocellular carcinoma (HCC). However, the increased tumor hypoxia and acidification will lead to the immunosuppressive tumor microenvironment (TME) featuring exhausted T cells, limiting the effectiveness of subsequent therapies following TACE. Herein, a stable water-in-oil lipiodol Pickering emulsion by employing calcium phosphate nanoparticles (CaP NPs) as stabilizers is developed and used to encapsulate L-arginine (L-Arg), which is known for its ability to modulate T-cell metabolism. The obtained L-Arg-loaded CaP-stabilized lipiodol Pickering emulsion (L-Arg@CaPL) with great emulsion stability can not only neutralize the tumor acidity via reaction of CaP NPs with protons but also enable the release of L-Arg, thereby synergistically promoting the reinvigoration of exhausted CD8+ T cells and effectively reversing tumor immunosuppression. As a result, TACE therapy with L-Arg@CaPL shows greatly improved therapeutic responses as demonstrated in an orthotopic liver tumor model in rats. This study highlights an effective yet simple nanoparticle-stabilized Pickering emulsion strategy to promote TACE therapy via modulation of the immunosuppressive TME, presenting great potential for clinical translation.

Safety and efficacy of percutaneous arterial port Implantation for Hepatic Arterial Infusion Chemotherapy

OBJECTIVES

Approximately 40% of patients with colorectal cancer will develop liver metastases. Hepatic arterial infusion chemotherapy (HAIC) represents a valuable treatment option, with curative, palliative, or adjuvant intent. The aim of our study was to describe technical considerations, safety, and oncological outcomes of patients receiving HAIC.

MATERIALS AND METHODS

All patients who underwent percutaneous hepatic arterial port placement in our institution between 2004 and 2021 were included in this retrospective analysis. Demographic, anatomical and technical data were collected. Tumor response was assessed using RECIST 1.1. Kaplan-Meier estimates were used for overall survival (OS) and hepatic progression-free survival (PFS). Adverse events (AEs) were graded using the Clavien-Dindo classification.

RESULTS

A total of 360 patients (median age, 58.6 years [interquartile range (IQR): 49.5-65.4]; 208 men [57.8%]) were included. Percutaneous hepatic arterial port placement was successful in 87.9% of cases, resulting in 379 port placements (431 attempts). Overall, 394 HAIC courses were delivered, mostly oxaliplatin-based (94.7%), with a median of 6 cycles per course (IQR: 3-8). AEs (all grades) were observed in 42.0% of ports (grade IIIb-V: 1.1%). Most port dysfunctions could be resolved, resulting in a 73.1% rate of HAIC resumption, without impact on OS. Median OS was 22 months (IQR: 18-24), and median hepatic PFS was 11 months (IQR: 9.5-13). Tumor downstaging allowed surgery in 35.6% of patients, with significantly longer median OS than non-operated patients (39 months [IQR: 33-79] versus 14 months [IQR: 12-16], p < 0.001).

CONCLUSION

This retrospective cohort study demonstrates the feasibility, safety, and efficacy of percutaneous hepatic arterial port placement with an impact on survival for selected patients.

CLINICAL RELEVANCE STATEMENT

Percutaneous hepatic arterial port placement is feasible, safe and effective with an impact on the survival of selected patients.

KEY POINTS

Hepatic arterial infusion chemotherapy provides promising tumor response and overall survival, especially in cases of resection/ablation. Total complication rate of hepatic arterial infusion chemotherapy port use is high, but serious complications are rare. Port revision is often necessary but allows the resumption of hepatic arterial infusion chemotherapy without affecting overall survival.

Lenvatinib and tislelizumab versus atezolizumab and bevacizumab in combination with TAE-HAIC for unresectable hepatocellular carcinoma with high tumor burden: a multicenter retrospective cohort study

BACKGROUND

Systemic and locoregional combination therapy has demonstrated promising outcomes for unresectable hepatocellular carcinoma (HCC); However, the best combination option remains unknown. This study compared the efficacy and safety of lenvatinib and tislelizumab versus atezolizumab and bevacizumab in combination with transarterial embolization (TAE) plus hepatic artery infusion chemotherapy (HAIC) for unresectable HCC with high tumor burden.

METHODS

This multicenter retrospective cohort study enrolled treatment-naive patients with unresectable HCC treated with TAE-HAIC plus lenvatinib and tislelizumab (THLP group) or TAE-HAIC plus atezolizumab and bevacizumab (THTA group). The primary endpoint was overall survival (OS). Secondary endpoints included progression-free survival (PFS), tumor response, and adverse events (AEs). Propensity score matching (PSM) was performed to reduce bias.

RESULTS

Of the 240 patients enrolled, 153 and 51 patients were assigned to the THLP and THTA groups, respectively after PSM (3:1). The THLP group showed a longer median OS (22 months vs. 18.2 months; P = 0.412), whereas the median PFS was longer in the THTA group (8.1 months vs. 7 months; P = 0.723), with statistically insignificant intergroup differences. No statistical differences were observed in objective response rate (RECIST 1.1: 33.9 vs. 31.4%; mRECIST: 77.1% vs. 74.5%; P = 0.635), disease control rate (RECIST 1.1: 88.9% vs. 92.2; mRECIST: 92.2% vs. 94.1%; P = 0.716), and in grade 3/4 AEs. Gastrointestinal hemorrhage rate was significantly higher in the THTA group (9.1% vs. 1.6%; P = 0.007). All AEs were controllable and no treatment-related grade 5 AEs occurred.

CONCLUSIONS

TAE-HAIC plus lenvatinib and tislelizumab or TAE-HAIC plus atezolizumab and bevacizumab showed similar outcomes for unresectable HCC with high tumor burden, and manageable safety. The results need further validation.

Manganese Galvanic Cells Intervene in Tumor Metabolism to Reinforce cGAS-STING Activation for Bidirectional Synergistic Hydrogen-Immunotherapy

The cGAS-STING pathway is pivotal in initiating antitumor immunity. However, tumor metabolism, particularly glycolysis, negatively regulates the activation of the cGAS-STING pathway. Herein, Mn galvanic cells (MnG) are prepared via liquid-phase exfoliation and in situ galvanic replacement to modulate tumor metabolism, thereby enhancing cGAS-STING activation for bidirectional synergistic H2-immunotherapy. The obtained MnG can be etched by water, enabling efficient and sustained generation of H2 gas and Mn2+. MnG not only activated and amplified the cGAS-STING pathway through the sustained release of Mn2+ but also regulated tumor glucose metabolism to inhibit the expression of three prime repair exonuclease 2 (TREX2), thereby synergistically enhancing the activation of the cGAS-STING pathway. The injection of MnG into tumors resulted in a robust immune response, thereby providing favorable support for antitumor therapy. Consequently, the combination of MnG with immune checkpoint blockade therapy resulted in significant suppression of both primary tumors and distant tumors. Furthermore, the MnG-lipiodol dispersion exhibited remarkable efficacy in combination with transarterial embolization (TAE)-gas-immunotherapy in a rabbit orthotopic liver tumor model. The present study underscores the significance of employing a metal galvanic cell strategy for enhanced immunotherapy, thereby offering a novel approach for rational design of bioactive materials to augment immunotherapeutic effectiveness.

Transarterial Chemoembolization With or Without Systemic Therapy for Unresectable Hepatocellular Carcinoma: A Retrospective Comparative Study

INTRODUCTION

Standard treatments provide limited benefits for patients with intermediate- or advanced-stage hepatocellular carcinoma (HCC). This retrospective observational study aimed to assess the potential improvements in outcomes associated with systemic therapies in patients receiving transarterial chemoembolization (TACE) for initially unresectable HCC.

METHODS

Between February 2019 and March 2023, we reviewed patients diagnosed with intermediate-to-advanced HCC who were treated with either TACE or TACE combined with antiangiogenic agents and immune checkpoint inhibitors (combination therapy) as their initial treatment. To address potential confounding biases, patients were further stratified into surgical and non-surgical cohorts, and separate analyses were conducted. The primary endpoints were progression-free survival (PFS) and overall survival (OS), with safety profiles also evaluated.

RESULTS

Among 279 patients with initially unresectable intermediate or advanced HCC, 156 successfully underwent curative-intent liver resection after preoperative treatments (TACE group, n = 69; combination group, n = 87), while 123 patients continued with non-surgical treatments (TACE group, n = 31; combination group, n = 92). After propensity score matching, 26 matched patient pairs were generated within the non-surgical cohort. The combination group exhibited significantly improved PFS in non-surgical patients compared with the TACE group (9.4 vs. 7.2 months, p = 0.043). Cox proportional hazards analysis further confirmed that combination therapy was associated with improved PFS (hazard ratio = 0.476, 95% confidence interval: 0.257-0.883, p = 0.019). For surgical patients exceeding the up-to-seven criteria, the combination group demonstrated superior median PFS (18.0 vs. 14.6 months, p = 0.03) and OS (not reached vs. 50.1 months, p = 0.049) compared with the TACE group. Adverse events were manageable, with no treatment-related fatalities reported.

CONCLUSION

Combination therapy with TACE demonstrated enhanced survival benefits for patients with intermediate to advanced HCC, particularly in surgical patients with higher tumor burdens.

Extracellular matrix stiffness regulates colorectal cancer progression via HSF4

BACKGROUND

Colorectal cancer (CRC) has high incidence and mortality rates, with severe prognoses during invasion and metastasis stages. Despite advancements in diagnostic and therapeutic technologies, the impact of the tumour microenvironment, particularly extracellular matrix (ECM) stiffness, on CRC progression and metastasis is not fully understood.

METHODS

This study included 107 CRC patients. Tumour stiffness was assessed using magnetic resonance elastography (MRE), and collagen ratio was analysed with Masson staining. CRC cell lines were cultured on matrices of varying stiffness, followed by transcriptome sequencing to identify stiffness-related genes. An HSF4 knockout CRC cell model was cultured in different ECM stiffness to evaluate the effects of HSF4 on cell proliferation, migration, and invasion in vitro and in vivo.

RESULTS

CRC tumour stiffness was significantly higher than normal tissue and positively correlated with collagen content and TNM staging. High-stiffness matrices significantly regulated cell functions and signalling pathways. High HSF4 (heat shock transcriptional factor 4) expression was strongly associated with tumour stiffness and poor prognosis. HSF4 expression increased with higher TNM stages, and its knockout significantly inhibited cell proliferation, migration, and invasion, especially on high-stiffness matrices. In vivo experiments confirmed that HSF4 promoted tumour growth and metastasis, independent of collagen protein increase.

CONCLUSIONS

This study reveals that tumour stiffness promotes the proliferation and metastasis of CRC by regulating EMT-related signalling pathways through HSF4. Tumour stiffness and HSF4 could be valuable targets for prognostic assessment and therapeutic intervention in CRC.

Mechanism of Shashen-Maidong herb pair in treating hepatocellular carcinoma using network pharmacology and experimental validation

ETHNOPHARMACOLOGICAL RELEVANCE

Hepatocellular carcinoma (HCC) is among the most prevalent malignant tumors globally and represents a significant public health issue worldwide. Immune cell dysfunction is the crucial factor for the formation of immunosuppression microenvironment of HCC. Glehnia littoralis (A.Gray) F.Schmidt ex Miq. (Shashen) and Ophiopogon japonicus (Thunb.) Ker Gawl. (Maidong) are classic herb pair in traditional Chinese medicine (TCM) of nourishing Yin, and is widely applied in the treatment of HCC and possesses multiple immunomodulatory functions. However, the role of the Shashen-Maidong herb pair (SS-MD) for the management of HCC and the potential mechanisms has not been explicated.

AIM OF THE STUDY

The purpose of the research is to investigate the potential mechanism of the SS-MD herb pair for the management of HCC.

MATERIALS AND METHODS

The known components of the SS-MD herb pair were preliminarily identified using UPLC-Q-Orbitrap-MS/MS. The active ingredients of SS-MD herb pair in treating HCC were screened by constructing herb-component-target network, and the key therapeutic targets were explored by constructing a protein-protein interaction (PPI) network. The binding affinity of the key targets and components were validated through molecular docking and molecular dynamics simulations. GO biological function and KEGG pathway analyses were operated to elucidate the potential mechanisms of the SS-MD herb pair for the management of HCC. And the mechanism was verified in the tumor bearing mice model and cell co-culture experiments.

RESULTS

Network pharmacology prediction revealed 39 active components and 138 targets of the SS-MD herb pair for the treatment of HCC. KEGG analysis mainly focused on Notch signaling pathway and Apoptosis signaling pathway. The targets were enriched in biological functions of lymphocyte effector function and lymphocyte apoptosis. In vivo and in vitro experiments proved that the SS-MD herb pair can improve the proportion of CD8+T cells in the HCC immune microenvironment, regulate its subgroup distribution. SS-MD herb pair promoted CD8+T cells to secrete IL-2, TNF-α, IFN-γ, Granzyme B and Perforin, and inhibited apoptosis by regulating Notch signaling pathway.

CONCLUSIONS

This study identified the key components, targets, and signaling pathways of the SS-MD herb pair, confirm that SS-MD herb pair play an immunomodulatory role in treating HCC, provides theoretical support for the collaborative treatment of HCC with TCM.

TRACE Model: Predicting Treatment Response to Transarterial Chemoembolization in Unresectable Hepatocellular Carcinoma

Purpose

To develop and validate a predictive model for predicting six-month outcome by integrating pretreatment MRI features and one-month treatment response after TACE.

Methods

A total of 108 patients with 160 hCCs from a single-arm, multicenter clinical trial (NCT03113955) were analyzed and served as the training cohort. An external multicenter dataset (ChiCTR2100046020) consisting of 63 patients with 99 hCCs served as the test dataset. Radiomics model was constructed based on the selected features from pretreatment MR images. Univariate and multivariate logistic regression analysis of clinical and radiological factors were used to identify the independent predictors for the 6-month treatment response. A combined model was further constructed by incorporating one-month treatment response, selected clinical and radiological factors and radiomics signature.

Results

Among all the clinical and radiological features, only corona enhancement and one-month treatment response were selected. The combined model, named TRACE model (Treatment response at 1 month, RAdiomics and Corona Enhancement), with AUCs of 0.91 (training cohort) and 0.84 (test cohort). The TRACE model demonstrated a significantly higher AUC than the radiomics model (P = 0.001). High-risk and low-risk groups stratified by using the TRACE model also exhibited significant differences in overall survival (OS) (P < 0.001). In contrast, none of the published scoring systems, including ART, SNACOR or ABCR score, demonstrated significant differences between the risk groups in OS prediction.

Conclusion

The TRACE model exhibited favorable predictive capability for six-month TACE response, and holds potential as a marker for long-term survival outcomes.

Clinical Outcomes of Hepatic Arterial Infusion Chemotherapy Plus Lenvatinib and Tislelizumab for Treating Hepatocellular Carcinoma and Type IV Portal Vein Tumor Thrombus

Purpose

To assess the activity and toxicity of hepatic arterial infusion chemotherapy (HAIC)+tislelizumab+lenvatinib (HAIC+tisle+len) in hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT) type IV (Vp4 hCC) in a real-world context.

Methods

Fifty-five patients, with Vp4 hCC receiving HAIC+tisle+len therapy from April 2021 to December 2022, were analyzed retrospectively. Data on patient characteristics, adverse events (AEs), treatment, and survival were collected. Outcomes were disease control rate (DCR), overall response rate (ORR), overall survival (OS), progression-free survival (PFS), and treatment-related AEs (TRAEs).

Results

As of December 20, 2023, the median follow-up was 17.5 months (95% confidence interval [CI]: 14.7-22.5). The ORR was 52.7% (3 complete response [CR], 26 partial response [PR]) as per RECIST v1.1 and 65.5% (12 CR, 24 PR) as per mRECIST. The DCR was 94.5% using both RECIST v1.1 and mRECIST. The median PFS and the median OS were 8.0 months (95% CI: 6.2-12.3) and 16.7 months (95% CI: 12.0-not reached), respectively. Additionally, PFS was independently predicted only by the best tumor response. In patients with the best tumor response (PR or CR), the median PFS was 11.7 months (95% CI: 8.02-not reached) by mRECIST and 15.4 months (95% CI: 7.39-not reached) by RECIST v1.1. Hypertension (14.5%), decreased albumin levels (10.9%) and anorexia (9.1%) were the most frequently observed grade 3-4 TRAEs.

Conclusion

HAIC+tisle+len regimen demonstrated a promising efficacy and favorable safety for patients with HCC and Vp4, providing valuable real-world evidence to complement the trial data for Vp4 hCC.

PD(L)1 Inhibitors Plus Lenvatinib Vs Atezolizumab Plus Bevacizumab Combined With HAIC for Unresectable HCC: A Propensity Score Matching Study

Purpose

To compare the clinical outcomes of different systemic therapies, specifically PD(L)1 inhibitors plus Lenvatinib versus Atezolizumab plus Bevacizumab, when combined with hepatic arterial infusion chemotherapy (HAIC) based on the FOLFOX regimen (oxaliplatin, fluorouracil, and leucovorin) as first line treatment for unresectable hepatocellular carcinoma.

Patients and Methods

This real-world retrospective study enrolled 294 patients with unresectable HCC. All patients received HAIC in combination with either PD(L)1 inhibitors plus Lenvatinib (PLEN-HAIC) or Atezolizumab plus Bevacizumab (AT-HAIC). Propensity score matching (PSM) was performed to balance patient characteristics. The overall response rate (ORR), progression-free survival (PFS), and overall survival (OS) were compared.

Results

After PSM, 80 and 130 patients received AT-HAIC and PLEN-HAIC, respectively. No significant differences were found in ORR between the AT-HAIC and PLEN-HAIC groups (50.0% vs 40.0% per RECIST, p = 0.202; 60.0% vs 57.7% per mRECIST, p = 0.853). Both groups showed similar disease control rates. Median PFS was 14.3 months for PLEN-HAIC versus 8.8 months for AT-HAIC (p = 0.018). Median OS was significantly better in the PLEN-HAIC group (p = 0.045, both not reached). Subgroup analysis revealed that Lenvatinib showed a better OS compared to Bevacizumab when combined with HAIC and PDL1 inhibitors (p = 0.023).

Conclusion

PLEN-HAIC offers significant survival benefits over AT-HAIC in advanced HCC. Given its remarkable efficacy, PLEN-HAIC could be a promising first-line option for unresectable HCC.

Nanoenzyme-based sensors for the detection of anti-tumor drugs

Natural enzymes are a class of biological catalysts that can catalyze a specific substrate. Although natural enzymes have catalytic activity, they are susceptible to the influence of external environment such as temperature, and storage requirements are more stringent. Since the first discovery of magnetic Fe3O4 nanoparticles with peroxidase-like activity in 2007, the research on nanoenzymes has entered a rapid development stage. Nanoenzymes synthesized by chemical methods not only have the catalytic activity of natural enzymes but also are more stable, easy to store, and convenient to prepare. Anthracyclines, as a commonly used anti-tumor chemotherapy drug, will produce many side effects such as myelosuppression and liver function damage after long-term use, which will affect its therapeutic effects. This paper reviews the characteristics, classification, and mechanisms of nanoenzymes. The detection of anti-tumor drugs, especially anthracycline drugs, using a nanoenzyme-based sensor was emphatically introduced. On this basis, the application of nanoenzyme-based sensors in the detection of anti-tumor drugs is  prospected.

A Machine Learning Model for Predicting Prognosis in HCC Patients With Diabetes After TACE

Purpose

Type II diabetes mellitus (T2DM) has been found to increase the mortality of patients with hepatocellular carcinoma (HCC). Therefore, this study aimed to establish and validate a machine learning-based explainable prediction model of prognosis in patients with HCC and T2DM undergoing transarterial chemoembolization (TACE).

Patients and Methods

The prediction model was developed using data from the derivation cohort comprising patients from three medical centers, followed by external validation utilizing patient data extracted from another center. Further, five predictive models were employed to establish prognosis models for 1-, 2-, and 3-year survival, respectively. Prediction performance was assessed by the receiver operating characteristic (ROC), calibration, and decision curve analysis curves. Lastly, the SHapley Additive exPlanations (SHAP) method was used to interpret the final ML model.

Results

A total of 636 patients were included. Thirteen variables were selected for the model development. The final random survival forest (RSF) model exhibited excellent performance in the internal validation cohort, with areas under the ROC curve (AUCs) of 0.824, 0.853, and 0.810 in the 1-, 2-, and 3-year survival groups, respectively. This model also demonstrated remarkable discrimination in the external validation cohort, achieving AUCs of 0.862, 0.815, and 0.798 in the 1-, 2-, and 3-year survival groups, respectively. SHAP summary plots were also created to interpret the RSF model.

Conclusion

An RSF model with good predictive performance was developed by incorporating simple parameters. This prognostic prediction model may assist physicians in early clinical intervention and improve prognosis outcomes in patients with HCC and comorbid T2DM after TACE.

Deep learning-based CT radiomics predicts prognosis of unresectable hepatocellular carcinoma treated with TACE-HAIC combined with PD-1 inhibitors and tyrosine kinase inhibitors

OBJECTIVE

To develop and validate a computed tomography (CT)-based deep learning radiomics model to predict treatment response and progression-free survival (PFS) in patients with unresectable hepatocellular carcinoma (uHCC) treated with transarterial chemoembolization (TACE)-hepatic arterial infusion chemotherapy (HAIC) combined with PD-1 inhibitors and tyrosine kinase inhibitors (TKIs).

METHODS

This retrospective study included 172 patients with uHCC who underwent combination therapy of TACE-HAIC with TKIs and PD-1 inhibitors. Among them, 122 were from the Interventional Department of the Harbin Medical University Cancer Hospital, with 92 randomly assigned to the training cohort and 30 cases randomly assigned to the testing cohort. The remaining 50 cases were from the Interventional Department of the Affiliated Fourth Hospital of Harbin Medical University and were used for external validation. All patients underwent liver enhanced CT examination before treatment. Residual convolutional neural network (ResNet) technology was used to extract image features. A predictive model for treatment response of combination therapy and PFS was established based on image features and clinical features. Model effectiveness was evaluated using metrics such as the area under the receiver operating characteristic (ROC) curve (AUC), concordance index (C-index), accuracy, precision, and F1-score.

RESULTS

All patients had a median follow-up of 25.2 months (95% CI 24.4-26.0), with a median PFS of 14.0 months (95% CI 8.5-19.4) and a median overall survival (OS) of 26.2 months (95% CI 15.9-36.4) achieved. Objective response rate (ORR) and disease control rate (DCR) was 41.0% and 55.7%, respectively. In the treatment response prediction model, the AUC for the training cohort reached 0.96, with an accuracy of 89.5%, precision of 85.6%, and F1-score of 0.896; the AUC for the testing cohort was 0.87, with an accuracy of 80.4%, precision of 74.5%, and F1-score of 0.802. The AUC of the external validation cohort was 0.85, with accuracy of 79.1%, precision of 73.6%, and f1-score of 0.784. In the PFS prediction model, the predicted AUC for 12 months, 18 months, and 24 months-PFS in the training cohort were 0.874, 0.809, 0.801, respectively. The AUC of testing cohort were 0.762, 0.804, 0.792. The AUC of external validation cohort were 0.764, 0.796, 0.773. The C-index of the combination model, radiomics model, and clinical model were 0.75, 0.591, and 0.655, respectively. The calibration curve demonstrated that the combination model was significantly superior to both the radiomics and clinical models.

CONCLUSIONS

The study provides a CT-based radiomics model that can predict PFS for patients with uHCC treated with TACE-HAIC combined with PD-1 and TKIs.

A new prognostic model for predicting overall survival and progression-free survival in unresectable hepatocellular carcinoma treated with the FOLFOX-HAIC regimen based on patient clinical characteristics and blood biomarkers

BACKGROUND

We developed a prognostic model to evaluate the overall survival (OS) and progression-free survival (PFS) of patients with unresectable hepatocellular carcinoma (u-HCC) treated with Hepatic arterial infusion chemotherapy of infusion oxaliplatin, fluorouracil and leucovorin (FOLFOX-HAIC).

METHODS

This model was based on a retrospective study of u-HCC patients treated with the FOLFOX-HAIC (oxaliplatin 130 mg/m2, leucovorin 400 mg/m2, fluorouracil bolus 400 mg/m2 on day 1, and fluorouracil infusion 2,400 mg/m2 for 23-46 h, once every 3-4 weeks). We divided the patients into a training cohort and a validation cohort, used LASSO regression construct prognostic models, predict patient's OS and PFS based on nomograms of models. Patients were divided into high-risk, medium-risk, and low-risk groups according to their respective model risk scores. Kaplan-Meier survival analysis was used to assess the survival time between the three patient cohorts.

RESULTS

A total of 333 patients were enrolled in the study and divided into a training cohort and a verification cohort at a ratio of 7:3 (233 in the training cohort and 100 in the validation cohort). The prognostic model we established contained nine prognostic variables. The results of concordance index (C-index) of the OS and PFS prognostic model was 0.75 and 0.71, respectively, higher than that of the TNM staging (0.57 and 0.55, p < 0.001), time-dependent ROC (td-ROC), net reclassification improvement (NRI), integrated discrimination improvement (IDI), and decision curve analysis (DCA) also showed that the model was better than the TNM staging for u-HCC predicting OS and PFS. Subsequently, the model was used to develop a nomogram to predict the individualized prognosis of patients with u-HCC treated with the FOLFOX-HAIC, with a higher net benefit than the TMN staging. According to the risk score, patients were divided into a low-risk group (risk score ≤ 0.458), the medium-risk group (risk score: 0.458-0.799) and the high-risk group (risk score > 0.799). There were significant differences in the OS and PFS between the three groups.

CONCLUSIONS

The model developed by our team enables risk stratification and personalized prognosis assessment for u-HCC patients undergoing FOLFOX-HAIC treatment, exhibiting superior predictive accuracy and discriminative capability compared to TNM staging.

Safety and efficacy of PD-1 inhibitor (sintilimab) combined with transarterial chemoembolization as the initial treatment in patients with intermediate-stage hepatocellular carcinoma beyond up-to-seven criteria

BACKGROUND

Numerous studies have demonstrated limited survival benefits of transarterial chemoembolization (TACE) alone in the treatment of intermediate-stage hepatocellular carcinoma (HCC) beyond up-to-seven criteria. The advent of immunotherapy, particularly immune checkpoint inhibitors (ICIs), has opened new avenues for HCC treatment. However, TACE combined with ICIs has not been investigated for patients with intermediate-stage HCC beyond the up-to-seven criteria. The study aims to evaluate the efficacy and safety of this treatment strategy for such patients.

METHODS

In this single-arm, prospective, phase II study, we enrolled eligible patients with HCC who were treated with TACE plus programmed cell death protein 1 (PD-1) inhibitors (sintilimab) from April 2021 to February 2023. The study's primary objectives were to assess progression-free survival (PFS) and safety. Secondary objectives included measuring the objective response rate (ORR) and disease control rate (DCR) as per both Response Evaluation Criteria in Solid Tumors (RECIST) V.1.1 and modified RECIST (mRECIST) criteria, as well as overall survival (OS). Additionally, we conducted correlation analyses to identify predictors influencing the efficacy of tumor treatment.

RESULT

20 patients participated in this study, with a median follow-up duration of 22.0 months. Median PFS was 8.4 months (95% CI: 4.7 to 19.7) according to both RECIST V.1.1 and mRECIST. The ORR was 30.0% (95% CI: 14.6% to 51.9%) per RECIST 1.1% and 60% (95% CI: 38.7% to 78.1%) per mRECIST. DCR was 95.0% (95% CI: 76.4% to 99.1%) according to both RECIST V.1.1 and mRECIST. Median OS was not yet reached. Notably, 20% (4/20) of patients underwent successful conversion to curative surgical resection. Treatment-related adverse events (TRAEs) mainly included elevated aspartate aminotransferase levels (19/20, 95.0%), elevated alanine aminotransferase levels (18/20, 90.0%), hypothyroidism (18/20, 90.0%), and reduced appetite (10/20, 50.0%). Among all participants, only one experienced grade 3 TRAE (myocarditis). We employed the Elastic Net regression model to analyze radiomic features from tumor and peritumoral areas to predict the efficacy of this treatment strategy.

CONCLUSION

TACE plus PD-1 inhibitors demonstrated promising efficacy and an acceptable safety profile, suggesting it as a potential treatment option for patients with intermediate-stage HCC beyond up-to-seven criteria. Furthermore, our study indicates that specific image-based features may serve as predictors for patients likely to benefit from this treatment approach.

TRIAL REGISTRATION NUMBER

NCT04842565.