1
|
Liu L, He W, Liu J. Camrelizumab Combined with Transcatheter Arterial Chemoembolization for Intermediate or Advanced Hepatocellular Carcinoma: A Systematic Review and Meta-analysis. Clin Res Hepatol Gastroenterol 2024:102465. [PMID: 39276855 DOI: 10.1016/j.clinre.2024.102465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 07/29/2024] [Accepted: 09/12/2024] [Indexed: 09/17/2024]
Abstract
OBJECTIVE This review assesses the efficacy and safety of the combination of transarterial chemoembolization (TACE) and camrelizumab for treating advanced hepatocellular carcinoma (HCC) and is to provide a goal, evidence-based medical foundation for effectively guiding clinical practice. METHODS We conducted a computerized search of six electronic databases to identify studies pertinent to the combination of TACE and camrelizumab for treating advanced HCC. For further analysis of clinical indicators and adverse events data, we utilized random or fixed-effect models to account for heterogeneity between studies. RESULTS As of May 30, 2023, 12 articles were included for Meta-analysis, encompassing 1123 patients with advanced HCC. The results indicated that the combined objective response rate (ORR) and disease control rate (DCR) were 51.1% and 86.8%, respectively. Regarding survival indicators, the combined overall survival (OS) and progression-free survival (PFS) were 24.26 months and 11.84 months, respectively. Among the adverse events observed, the highest incidence rates for TACE combined with camrelizumab were fever (all grade: 46.5%, ≥grade III: 5.0%), hypertension (all grade: 32.2%, ≥grade III: 8.5%), transaminase elevation (all grade: 34.7%, ≥grade III: 13.4%), and nausea and vomiting (all grade: 43.9%, ≥grade III: 2.5%). CONCLUSIONS This study demonstrated the efficacy and safety of combining TACE with camrelizumab in treating patients with advanced HCC, providing valuable evidence for its prospective clinical application. However, due to the limited availability of clinical data, it is essential to design larger-scale and multi-center clinical randomized controlled trials in the future to validate and confirm these findings definitively.
Collapse
Affiliation(s)
- Li Liu
- Department of Oncology,Integrated Traditional Chinese and Western Medicine, The Central Hospital of Wuhan,Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
| | - Wenyu He
- Department of Oncology,Integrated Traditional Chinese and Western Medicine, The Central Hospital of Wuhan,Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jiaoping Liu
- Department of Oncology,Integrated Traditional Chinese and Western Medicine, The Central Hospital of Wuhan,Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| |
Collapse
|
2
|
Zheng Y, Xiang Y, Shi H, Lin Z, Cheng S, Zhu J. Transarterial Chemoembolization Combined with Atezolizumab Plus Bevacizumab versus Transarterial Chemoembolization Alone in Intermediate-stage Hepatocellular Carcinoma: A Multicenter Retrospective Study. J Hepatocell Carcinoma 2024; 11:1079-1093. [PMID: 38882440 PMCID: PMC11180435 DOI: 10.2147/jhc.s461630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 06/06/2024] [Indexed: 06/18/2024] Open
Abstract
Purpose Combining transarterial chemoembolization (TACE) with systemic therapy has shown significant efficacy for intermediate-stage hepatocellular carcinoma (HCC) patients. This study aimed to validate the therapeutic efficacy of TACE combined with atezolizumab and bevacizumab (TACE + Atez/Bev) compared to TACE alone. Methods A retrospective study was conducted across three centers in China, encompassing 155 patients at the intermediate-stage of HCC. Propensity Score Matching (PSM) was used to minimize selection bias, with a ratio of 1:1. Primary outcomes were TACE-specific Progression-Free Survival (PFS) and Overall Survival (OS). Objective Response Rate (ORR) and Disease Control Rate (DCR) were assessed based on the modified Response Evaluation Criteria in Solid Tumors (mRECIST). Adverse events (AEs) related to treatment were analyzed to evaluate safety. Results Before PSM, the TACE + Atez/Bev group demonstrated extended median OS (not reached vs 20.3 months, P = 0.004) and PFS (20.0 months vs 9.8 months, P = 0.029) compared to the TACE-alone group. The TACE + Atez/Bev group also had a higher ORR (60.9% vs 41.3%, P = 0.026) and DCR (89.1% vs 58.7%, P < 0.001) than the TACE-alone group. After applying the PSM, the study included 42 pairs of patients. Compared to the TACE-alone group, the combination therapy group also showed significantly longer median OS (not reached vs 21.4 months, P = 0.008) and PFS (21.7 vs 9.7 months, P = 0.009). The combination therapy group also had a higher ORR (66.7% vs 38.1%, P = 0.009) and DCR (92.9% vs 57.1%, P < 0.001). AEs in the combination therapy group were mostly manageable, with the most common being elevated liver transaminase. Conclusion In treating intermediate-stage HCC, the survival benefit of combining TACE with atezolizumab and bevacizumab was significantly higher than TACE alone, and the treatment was well-tolerated.
Collapse
Affiliation(s)
- Yitao Zheng
- Department of Pancreatic and Gastrointestinal Surgery Division, Ningbo No.2 Hospital, Ningbo, People's Republic of China
- Department of Hepatological Surgery, the First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Yanjun Xiang
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, People's Republic of China
| | - Hongqi Shi
- Department of Hepatological Surgery, the First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Zhuoqun Lin
- Department of Hepatological Surgery, the First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Shuqun Cheng
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, People's Republic of China
| | - Jiuting Zhu
- Department of Pancreatic and Gastrointestinal Surgery Division, Ningbo No.2 Hospital, Ningbo, People's Republic of China
| |
Collapse
|
3
|
Duan X, Li H, Kuang D, Chen P, Zhang K, Li Y, He X, Xing C, Wang H, Liu Y, Xie L, Zhang S, Zhang Q, Zhu P, Dong H, Xie J, Li H, Wang Y, Shi M, Jiang G, Xu Y, Zhou S, Shang C, Ren J, Han X. Transcatheter arterial chemoembolization plus apatinib with or without camrelizumab for unresectable hepatocellular carcinoma: a multicenter retrospective cohort study. Hepatol Int 2023; 17:915-926. [PMID: 37012542 PMCID: PMC10386927 DOI: 10.1007/s12072-023-10519-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 03/11/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND The evidence of transcatheter arterial chemoembolization (TACE) plus tyrosine kinase inhibitor and immune checkpoint inhibitor in unresectable hepatocellular carcinoma (HCC) was limited. This study aimed to evaluate the role of TACE plus apatinib (TACE + A) and TACE combined with apatinib plus camrelizumab (TACE + AC) in patients with unresectable HCC. METHODS This study retrospectively reviewed patients with unresectable HCC who received TACE + A or TACE + AC in 20 centers of China from January 1, 2019 to June 31, 2021. Propensity score matching (PSM) at 1:1 was performed to reduce bias. Treatment-related adverse events (TRAEs), overall survival (OS), progression-free survival (PFS), objective response rate (ORR) and disease control rate (DCR) were collected. RESULTS A total of 960 eligible patients with HCC were included in the final analysis. After PSM, there were 449 patients in each group, and the baseline characteristics were balanced between two groups. At data cutoff, the median follow-up time was 16.3 (range: 11.9-21.4) months. After PSM, the TACE + AC group showed longer median OS (24.5 vs 18.0 months, p < 0.001) and PFS (10.8 vs 7.7 months, p < 0.001) than the TACE + A group; the ORR (49.9% vs 42.5%, p = 0.002) and DCR (88.4% vs 84.0%, p = 0.003) of the TACE + AC group were also higher than those in the TACE + A group. Fever, pain, hypertension and hand-foot syndrome were the more common TRAEs in two groups. CONCLUSIONS Both TACE plus apatinib and TACE combined with apatinib plus camrelizumab were feasible in patients with unresectable HCC, with manageable safety profiles. Moreover, TACE combined with apatinib plus camrelizumab showed additional benefit.
Collapse
Affiliation(s)
- Xuhua Duan
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1, East Jian She Road, Zhengzhou, Henan Province, China
| | - Hao Li
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1, East Jian She Road, Zhengzhou, Henan Province, China
| | - Donglin Kuang
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1, East Jian She Road, Zhengzhou, Henan Province, China
| | - Pengfei Chen
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1, East Jian She Road, Zhengzhou, Henan Province, China
| | - Kai Zhang
- Department of Interventional Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Yanliang Li
- Department of Interventional and Oncology, Dengzhou People's Hospital, Nanyang, Henan, China
| | - Xiang He
- Department of Medical Imaging, Huaihe Hospital of Henan University, Kaifeng, Henan, China
| | - Cheng Xing
- Department of Interventional Radiology, Zhoukou Central Hospital, Zhoukou, Henan, China
| | - Haibo Wang
- Department of Interventional Radiology, Zhengzhou Central Hospital, Zhengzhou, Henan, China
| | - Yaoxian Liu
- Department of Interventional Radiology, Luohe Central Hospital, Luohe, Henan, China
| | - Limin Xie
- Department of Interventional Radiology, Shangqiu First People's Hospital, Shangqiu, Henan, China
| | - Shixi Zhang
- Department of Infection, Shangqiu Municipal Hospital, Shangqiu, Henan, China
| | - Qiang Zhang
- Department of Interventional Radiology, Anyang District Hospital, Anyang, Henan, China
| | - Peixin Zhu
- Department of Interventional Radiology, General Hospital of Pingmei Shenma Group, Pingdingshan, Henan, China
| | - Honglin Dong
- Department of Interventional Radiology, The People's Hospital of Anyang City, Anyang, Henan, China
| | - Jichen Xie
- Department of Interventional Radiology, The Fifth People's Hospital of Puyang City, Puyang, Henan, China
| | - Hui Li
- Department of Interventional Radiology, The People's Hospital of Jiaozuo City, Jiaozuo, Henan, China
| | - Yong Wang
- Department of Interventional Vascular Surgery, The Second Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Ming Shi
- Department of Radiology, The Second Hospital of Xingtai, Xingtai, Hebei, China
| | - Guangbin Jiang
- Department of Interventional Radiology, Suizhou Central Hospital, Suizhou, Hubei, China
| | - Yandong Xu
- Department of CT-MRI, Erdos Central Hospital, Erdos, Inner Mongolia, China
| | - Shiqi Zhou
- Department of Interventional Radiology, North China University of Science and Technology Affiliated Hospital, Tangshan, Hebei, China
| | - Chunyu Shang
- Department of Interventional Radiology, Siping Central People's Hospital, Siping, Jilin, China
| | - Jianzhuang Ren
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1, East Jian She Road, Zhengzhou, Henan Province, China.
| | - Xinwei Han
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1, East Jian She Road, Zhengzhou, Henan Province, China.
| |
Collapse
|
4
|
Xie S, Wang M, Zeng C, Ou Y, Zhao L, Wang D, Chen L, Kong F, Yi D. Research progress of targeted therapy combined with immunotherapy for hepatocellular carcinoma. Front Oncol 2023; 13:1197698. [PMID: 37305582 PMCID: PMC10248438 DOI: 10.3389/fonc.2023.1197698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 05/16/2023] [Indexed: 06/13/2023] Open
Abstract
Hepatocellular carcinoma is a common gastrointestinal malignancy with a high mortality rate and limited treatment options. Molecularly targeted drugs combined with immune checkpoint inhibitors have shown unique advantages over single-agent applications, significantly prolonging patient survival. This paper reviews the research progress of molecular-targeted drugs combined with immune checkpoint inhibitors in the treatment of hepatocellular carcinoma and discusses the effectiveness and safety of the combination of the two drugs to provide a reference for the further application of molecular-targeted drugs combined with immune checkpoint inhibitors in clinical practice.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Liwei Chen
- Department of Oncology, The First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | | | | |
Collapse
|
5
|
Xia WL, Zhao XH, Guo Y, Hu HT, Cao GS, Li Z, Fan WJ, Xu SJ, Li HL. Transarterial Chemoembolization Combined With Apatinib Plus PD-1 Inhibitors for Hepatocellular Carcinoma With Portal Vein Tumor Thrombus: A Multicenter Retrospective Study. Clin Transl Gastroenterol 2023; 14:e00581. [PMID: 36920551 PMCID: PMC10208716 DOI: 10.14309/ctg.0000000000000581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 02/17/2023] [Indexed: 03/16/2023] Open
Abstract
INTRODUCTION The aim of this study was to compare transarterial chemoembolization (TACE) combined with apatinib and PD-1 inhibitors (TACE-AP) with TACE combined with apatinib alone (TACE-A) in the treatment of hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT) and to explore the prognostic factors affecting the survival of patients. METHODS This retrospective study analyzed data of patients with HCC with PVTT who were treated with TACE-AP or TACE-A between December 2018 and June 2021. The primary end points of the study were progression-free survival (PFS) and overall survival (OS), and the secondary end points were objective response rate (ORR) and adverse events (AEs). Propensity score matching (PSM) and stabilized inverse probability weighting (sIPTW) analyses were used to reduce patient selection bias, and Cox regression analysis was used to analyze prognostic factors affecting patient survival. RESULTS Sixty-nine and 40 patients were included in the TACE-A and TACE-AP groups, respectively. After PSM and IPTW analyses, the median PFS and median OS in the TACE-AP group were significantly higher than those in the TACE-A group (PFS: after PSM, 6.9 vs 4.0 months, P < 0.001, after IPTW, 6.5 vs 5.1 months, P < 0.001; OS: after PSM, 14.6 vs 8.5 months P < 0.001, after IPTW, 16.1 vs 10.5 months, P < 0.001). After PSM and IPTW analyses, the tumor ORR in the TACE-AP group was significantly higher than that in the TACE-A group (PSM, 53.6% vs 17.9%, P = 0.005; IPTW, 52.5% vs 28.6%, P = 0.013). All treatment-related AEs were observed to be tolerated. Multivariate Cox regression analysis showed that the main prognostic factors affecting the survival of patients were tumor number, PVTT type, alpha-fetoprotein, and treatment mode. DISCUSSION In the treatment of patients with HCC with PVTT, TACE-AP significantly improved PFS, OS, and ORR, and the AEs were safe and controllable.
Collapse
Affiliation(s)
- Wei-Li Xia
- Department of Minimal-Invasive Intervention, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Xiao-Hui Zhao
- Department of Minimal-Invasive Intervention, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Yuan Guo
- Department of Minimal-Invasive Intervention, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Hong-Tao Hu
- Department of Minimal-Invasive Intervention, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Guang-Shao Cao
- Department of Intervention, Henan Provincial People's Hospital, Zhengzhou, China
| | - Zhen Li
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wei-Jun Fan
- Department of Minimally Invasive Interventional Radiology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Shi-Jun Xu
- Department of Minimal-Invasive Intervention, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Hai-Liang Li
- Department of Minimal-Invasive Intervention, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| |
Collapse
|
6
|
Han CL, Tian BW, Yan LJ, Ding ZN, Liu H, Mao XC, Tian JC, Xue JS, Tan SY, Dong ZR, Yan YC, Hong JG, Chen ZQ, Wang DX, Li T. Efficacy and safety of immune checkpoint inhibitors for hepatocellular carcinoma patients with macrovascular invasion or extrahepatic spread: a systematic review and meta-analysis of 54 studies with 6187 hepatocellular carcinoma patients. Cancer Immunol Immunother 2023:10.1007/s00262-023-03390-x. [PMID: 36811662 DOI: 10.1007/s00262-023-03390-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 01/27/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND AND AIMS The impacts of macrovascular invasion (MVI) or extrahepatic spread (EHS) on the efficacy and safety of immune checkpoint inhibitors (ICIs) among hepatocellular carcinoma (HCC) patients remain unclear. Thus, we conducted a systematic review and meta-analysis to clarify whether ICI therapy is a feasible treatment option for HCC with MVI or EHS. METHODS Eligible studies published before September 14, 2022, were retrieved. In this meta-analysis, the objective response rate (ORR), progression-free survival (PFS), overall survival (OS), and occurrence of adverse events (AEs) were outcomes of interest. RESULTS Fifty-four studies involving 6187 individuals were included. The findings indicated that the presence of EHS in ICI-treated HCC patients may indicate an inferior ORR (OR 0.77, 95% CI 0.63-0.96), but may not significantly affect the PFS (multivariate analyses: HR 1.27, 95% CI 0.70-2.31) and OS (multivariate analyses: HR 1.23, 95% CI 0.70-2.16). Additionally, the presence of MVI in ICI-treated HCC patients may not have significant prognostic impact on ORR (OR 0.84, 95% CI 0.64-1.10), but may indicate inferior PFS (multivariate analyses: HR 1.75, 95% CI 1.07-2.84) and OS (multivariate analyses: HR 2.03, 95% CI 1.31-3.14). The presence of EHS or MVI in ICI-treated HCC patients may not significantly impact the occurrence of any serious immune-related adverse events (irAEs) (grades ≥ 3) (EHS: OR 0.44, 95% CI 0.12-1.56; MVI: OR 0.68, 95% CI 0.24-1.88). CONCLUSION The presence of MVI or EHS in ICI-treated HCC patients may not significantly impact the occurrence of serious irAEs. However, the presence of MVI (but not EHS) in ICI-treated HCC patients may be a significant negative prognostic factor. Therefore, ICI-treated HCC patients with MVI warrant more attention.
Collapse
Affiliation(s)
- Cheng-Long Han
- Department of General Surgery, Qilu Hospital, Shandong University, Jinan, 250012, People's Republic of China
| | - Bao-Wen Tian
- Department of General Surgery, Qilu Hospital, Shandong University, Jinan, 250012, People's Republic of China
| | - Lun-Jie Yan
- Department of General Surgery, Qilu Hospital, Shandong University, Jinan, 250012, People's Republic of China
| | - Zi-Niu Ding
- Department of General Surgery, Qilu Hospital, Shandong University, Jinan, 250012, People's Republic of China
| | - Hui Liu
- Department of General Surgery, Qilu Hospital, Shandong University, Jinan, 250012, People's Republic of China
| | - Xin-Cheng Mao
- Department of General Surgery, Qilu Hospital, Shandong University, Jinan, 250012, People's Republic of China
| | - Jin-Cheng Tian
- Department of General Surgery, Qilu Hospital, Shandong University, Jinan, 250012, People's Republic of China
| | - Jun-Shuai Xue
- Department of General Surgery, Qilu Hospital, Shandong University, Jinan, 250012, People's Republic of China
| | - Si-Yu Tan
- Department of General Surgery, Qilu Hospital, Shandong University, Jinan, 250012, People's Republic of China
| | - Zhao-Ru Dong
- Department of General Surgery, Qilu Hospital, Shandong University, Jinan, 250012, People's Republic of China
| | - Yu-Chuan Yan
- Department of General Surgery, Qilu Hospital, Shandong University, Jinan, 250012, People's Republic of China
| | - Jian-Guo Hong
- Department of General Surgery, Qilu Hospital, Shandong University, Jinan, 250012, People's Republic of China
| | - Zhi-Qiang Chen
- Department of General Surgery, Qilu Hospital, Shandong University, Jinan, 250012, People's Republic of China
| | - Dong-Xu Wang
- Department of General Surgery, Qilu Hospital, Shandong University, Jinan, 250012, People's Republic of China
| | - Tao Li
- Department of General Surgery, Qilu Hospital, The Second Hospital of Shandong University, 107 West Wen Hua Road, Jinan, 250012, People's Republic of China.
| |
Collapse
|
7
|
Shi Q, Zhou X, Zhang Z, Zhang W, Ma J, Yang M, Yu J, Luo J, Liu L, Yan Z. Microwave ablation and synchronous transarterial chemoembolization combined with PD-1 inhibitor in patients with hepatocellular carcinoma following tyrosine kinase inhibitor intolerance. Front Immunol 2023; 13:1097625. [PMID: 36703965 PMCID: PMC9871779 DOI: 10.3389/fimmu.2022.1097625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 12/20/2022] [Indexed: 01/12/2023] Open
Abstract
Purpose To determine the safety and efficacy of microwave ablation (MWA) and synchronous transarterial chemoembolization (TACE) combined with or without PD-1 inhibitor in patients with hepatocellular carcinoma (HCC) following tyrosine kinase inhibitor (TKI) intolerance. Materials and methods This study retrospectively enrolled TKI-intolerant HCC patients who underwent MWA-TACE combined with PD-1 inhibitor (MTP) or MWA-TACE (MT) from January 2019 to June 2021. MWA and TACE were performed simultaneously, and PD-1 inhibitor was administered intravenously at a dose of 200 mg once every three weeks after MWA-TACE. Adverse events (AEs) related to treatment were recorded during the follow-up. Progression-free survival (PFS) and overall survival (OS) were compared between the two groups. Results A total of 87 patients were included and classified into the MTP group (n =42) and MT group (n=45). Complications related to MWA-TACE in the MTP group were similar to that in the MT group (21.4% vs. 24.4%, P = 0.738). Moreover, 35 (83.3%) patients had eighty-four AEs related to PD-1 inhibitor in the MTP group, and 8 (19.0%) patients developed grade 3. Patients who underwent MWA-TACE combined with PD-1 inhibitor had better PFS (median, 10.0 vs. 4.7 months, P < 0.001) and OS (median, 17.0 vs. 8.5 months, P < 0.001) than those who underwent MWA-TACE alone. Treatment method and Child-Pugh class were independent prognostic factors for survival in the univariate and multivariate analysis. Conclusion MWA and synchronous TACE combined with PD-1 inhibitor might be a favorable treatment option in TKI-intolerant HCC patients.
Collapse
Affiliation(s)
- Qin Shi
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China,Department of Interventional Radiology, Shanghai Institution of Medical Imaging, Shanghai, China,National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xin Zhou
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China,Department of Interventional Radiology, Shanghai Institution of Medical Imaging, Shanghai, China,National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zihan Zhang
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China,Department of Interventional Radiology, Shanghai Institution of Medical Imaging, Shanghai, China,National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wen Zhang
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China,Department of Interventional Radiology, Shanghai Institution of Medical Imaging, Shanghai, China,National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jingqin Ma
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China,Department of Interventional Radiology, Shanghai Institution of Medical Imaging, Shanghai, China,National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Minjie Yang
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China,Department of Interventional Radiology, Shanghai Institution of Medical Imaging, Shanghai, China,National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jiaze Yu
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China,Department of Interventional Radiology, Shanghai Institution of Medical Imaging, Shanghai, China,National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jianjun Luo
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China,Department of Interventional Radiology, Shanghai Institution of Medical Imaging, Shanghai, China,National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lingxiao Liu
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China,Department of Interventional Radiology, Shanghai Institution of Medical Imaging, Shanghai, China,National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai, China,*Correspondence: Lingxiao Liu, ; Zhiping Yan,
| | - Zhiping Yan
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China,Department of Interventional Radiology, Shanghai Institution of Medical Imaging, Shanghai, China,National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai, China,*Correspondence: Lingxiao Liu, ; Zhiping Yan,
| |
Collapse
|
8
|
Yan J, Deng M, Kong S, Li T, Lei Z, Zhang L, Zhuang Y, He X, Wang H, Fan H, Guo Y. Transarterial chemoembolization in combination with programmed death-1/programmed cell death-ligand 1 immunotherapy for hepatocellular carcinoma: A mini review. ILIVER 2022; 1:225-234. [DOI: 10.1016/j.iliver.2022.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
|
9
|
Zhu D, Ma K, Yang W, Zhou HF, Shi Q, Ren JW, Xie YG, Liu S, Shi HB, Zhou WZ. Transarterial chemoembolization plus apatinib with or without camrelizumab for unresected hepatocellular carcinoma: A two-center propensity score matching study. Front Oncol 2022; 12:1057560. [DOI: 10.3389/fonc.2022.1057560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 10/24/2022] [Indexed: 11/11/2022] Open
Abstract
PurposeTo compare the effectiveness and safety of transarterial chemoembolization (TACE) combined with apatinib and camrelizumab with those of TACE as well as apatinib among patients with unresectable hepatocellular carcinoma (HCC).Materials and methodsThe data of patients with unresectable HCC (uHCC) who received TACE-apatinib-camrelizumab combination (TACE + AC group) and TACE-apatinib combination (TACE + A group) were collected from two centers between January 2018 and January 2022. Propensity score matching (PSM) was conducted to diminish the bias between the two groups. The primary outcome measures of the study were overall survival (OS) and progression-free survival (PFS), and the secondary outcome measures were response rate (ORR), disease control rate (DCR), and adverse events (AEs).ResultsA total of 102 patients were enrolled in this study after PSM, with 34 patients in the TACE + AC group and 68 patients in the TACE + A group. Compared to the TACE + A group, TACE + AC had a significantly longer median OS (25.5 months, interquartile range [IQR], 23.5–33.0) than 18.5 months (IQR, 13.0–25.0; P = 0.001). Similarly, the PFS of the TACE + AC group was significantly improved (14.0 months, IQR, 9.0–NA) compared to that of the TACE + A group (5.0 months, IQR, 2.5–9.0; P = 0.001). The ORR rates (55.9% vs. 51.5%), and DCR rates (79.4% vs. 72.1%) were comparable between groups (P > 0.05). All treatment-related adverse events were tolerable and manageable, and no serious adverse events were observed.ConclusionTACE combined with apatinib plus camrelizumab demonstrated superior efficacy to TACE plus apatinib for patients with unresectable HCC. The two combination therapies showed similar safety profiles.
Collapse
|
10
|
Xia WL, Zhao XH, Guo Y, Cao GS, Wu G, Fan WJ, Yao QJ, Xu SJ, Guo CY, Hu HT, Li HL. Transarterial chemoembolization combined with apatinib with or without PD-1 inhibitors in BCLC stage C hepatocellular carcinoma: A multicenter retrospective study. Front Oncol 2022; 12:961394. [PMID: 36249011 PMCID: PMC9562990 DOI: 10.3389/fonc.2022.961394] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 09/16/2022] [Indexed: 11/30/2022] Open
Abstract
Objective We evaluated the efficacy and safety of transarterial chemoembolization (TACE) combined with apatinib plus PD-1 inhibitors (TACE-AP) compared with TACE combined with apatinib (TACE-A) in patients with advanced hepatocellular carcinoma (HCC) and to explore the prognostic factors affecting patient survival. Methods Data from patients with unresectable HCC who received TACE-AP or TACE-A from December 2018 to June 2021 were collected retrospectively. The main outcome of the study was overall survival (OS) and prognostic factors affecting survival, while the secondary outcomes were progression-free survival (PFS), the objective response rate (ORR), and treatment-related adverse events (TRAEs). Propensity score matching (PSM) analysis was used to reduce patient selection bias, and the random survival forest (RF) model was employed to explore prognostic factors affecting patient survival. Results We enrolled 216 patients, including 148 and 68 patients in the TACE-A and TACE-AP groups, respectively. A total of 59 pairs of patients were matched using PSM analysis. Before and after PSM, the OS, PFS, and ORR in the TACE-AP group were significantly higher than in the TACE-A group (before, OS: 22.5 months vs. 12.8 months, P < 0.001; PFS: 6.7 months vs. 4.3 months, P < 0.001; ORR: 63.2% vs. 34.5%, P < 0.001; after, OS: 22.5 months vs. 12.0 months, P < 0.001; PFS: 6.7 months vs. 4.3 months, P < 0.001; ORR: 62.7% vs. 30.5%, P = 0.003). Multivariate Cox regression and RF models before and after PSM analysis revealed that the main prognostic factors affecting survival were tumor number, portal vein tumor thrombus (PVTT) invasion, alpha-fetoprotein (AFP) levels, total bilirubin (TBIL) level, and treatment. There was no significant difference in TRAEs between the two groups (P > 0.05). Conclusion Compared with TACE-A, TACE-AP significantly improved OS, PFS, and ORR in patients with advanced HCC. The number of tumors, PVTT invasion, AFP levels, TBIL level, and treatment were significant prognostic factors associated with patient survival. All observed TRAEs were mild and controllable.
Collapse
Affiliation(s)
- Wei-Li Xia
- Department of Minimal-Invasive Intervention, The Affiliated Cancer Hospital of Zhengzhou University&Henan Cancer Hospital, Zhengzhou, China
| | - Xiao-Hui Zhao
- Department of Minimal-Invasive Intervention, The Affiliated Cancer Hospital of Zhengzhou University&Henan Cancer Hospital, Zhengzhou, China
| | - Yuan- Guo
- Department of Minimal-Invasive Intervention, The Affiliated Cancer Hospital of Zhengzhou University&Henan Cancer Hospital, Zhengzhou, China
| | - Guang-Shao Cao
- Department of Intervention, Henan Provincial People’s Hospital, Zhengzhou, China
| | - Gang Wu
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wei-Jun Fan
- Department of Minimally Invasive Interventional Radiology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Quan-Jun Yao
- Department of Minimal-Invasive Intervention, The Affiliated Cancer Hospital of Zhengzhou University&Henan Cancer Hospital, Zhengzhou, China
| | - Shi-Jun Xu
- Department of Minimal-Invasive Intervention, The Affiliated Cancer Hospital of Zhengzhou University&Henan Cancer Hospital, Zhengzhou, China
| | - Chen-Yang Guo
- Department of Minimal-Invasive Intervention, The Affiliated Cancer Hospital of Zhengzhou University&Henan Cancer Hospital, Zhengzhou, China
| | - Hong-Tao Hu
- Department of Minimal-Invasive Intervention, The Affiliated Cancer Hospital of Zhengzhou University&Henan Cancer Hospital, Zhengzhou, China
- *Correspondence: Hong-Tao Hu, ; Hai-Liang Li,
| | - Hai-Liang Li
- Department of Minimal-Invasive Intervention, The Affiliated Cancer Hospital of Zhengzhou University&Henan Cancer Hospital, Zhengzhou, China
- *Correspondence: Hong-Tao Hu, ; Hai-Liang Li,
| |
Collapse
|
11
|
Four-Pyroptosis Gene-Based Nomogram as a Novel Strategy for Predicting the Effect of Immunotherapy in Hepatocellular Carcinoma. BIOMED RESEARCH INTERNATIONAL 2022; 2022:2680110. [PMID: 35782053 PMCID: PMC9242783 DOI: 10.1155/2022/2680110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 05/28/2022] [Indexed: 11/20/2022]
Abstract
Background Immunotherapy has been considered as a promising cancer treatment for hepatocellular carcinoma (HCC). However, due to the particular immune environment of the liver, identifying patients who could benefit from immunotherapy is critical in clinical practice. Methods The pyroptosis gene expression database of 54 candidates from The Cancer Genome Atlas (TCGA) were collected to discover the critical prognostic-related pyroptosis genes. A novel pyroptosis gene model was established to calculate the risk score. Kaplan–Meier analysis and receiver operating characteristic curve (ROC) were used to verify its predictive ability. The International Cancer Genome Consortium (ICGC) data was collected as external validation data to verify the model's accuracy. We employed multiple bioinformatics tools and algorithms to evaluate the tumor immune microenvironment (TIME) and the response to immunotherapy. Results Our study found that most pyroptosis genes were expressed differently in normal and tumor tissues and that their expression was associated with the prognosis. Then, a precise four-pyroptosis gene model was generated. The one-year area under the curves (AUCs) among the training, internal, and external validation patients were 0.901, 0.727, and 0.671, respectively. An analysis of survival data revealed that individuals had a worse prognosis than patients with low risk. The analysis of TIME revealed that the low-risk group had more antitumor cells, fewer immunosuppressive cells, stronger immune function, less immune checkpoint gene expression, and better immunotherapy response than the high-risk group. Immunophenoscore (IPS) analysis also demonstrated that the low-risk score was related to superior immune checkpoint inhibitors therapy. Conclusion A nomogram based on the four-pyroptosis gene signature was a novel tool to predict the effectiveness of immunotherapy for HCC. Therefore, individualized treatment targeting the pyroptosis genes may influence TIME and play an essential role in improving the prognosis in HCC patients.
Collapse
|
12
|
Ke Q, Xin F, Fang H, Zeng Y, Wang L, Liu J. The Significance of Transarterial Chemo(Embolization) Combined With Tyrosine Kinase Inhibitors and Immune Checkpoint Inhibitors for Unresectable Hepatocellular Carcinoma in the Era of Systemic Therapy: A Systematic Review. Front Immunol 2022; 13:913464. [PMID: 35677059 PMCID: PMC9167927 DOI: 10.3389/fimmu.2022.913464] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 04/26/2022] [Indexed: 12/21/2022] Open
Abstract
Background and Aims Regardless of great progress in early detection of hepatocellular carcinoma (HCC), unresectable HCC (uHCC) still accounts for the majority of newly diagnosed HCC with poor prognosis. With the promising results of a double combination of transarterial chemo(embolization) and tyrosine kinase inhibitors (TKIs), and TKIs and immune checkpoint inhibitors (ICIs), a more aggressive strategy, a triple combination of transarterial chemo(embolization), TKIs, and ICIs has been tried in the recent years. Hence, we aimed to conduct a systematic review to verify the safety and efficacy of the triple therapy for uHCC. Methods PubMed, MedLine, Embase, the Cochrane Library, and Web of Knowledge were used to screen the eligible studies evaluating the clinical efficacy and safety of triple therapy for patients with uHCC up to April 25th 2022, as well as Chinese databases. The endpoints were the complete response (CR), objective response rate (ORR), disease control rate (DCR), conversion rate, progression-free survival (PFS) rate, overall survival (OS) rate, and the incidence of adverse events (AEs). Results A total of 15 studies were eligible with 741 patients receiving transarterial chemoembolization (TACE) or hepatic arterial infusion chemotherapy (HAIC) combined with TKIs and ICIs. The pooled rate and 95% confidence interval (CI) for CR, ORR, and DCR were 0.124 (0.069–0.190), 0.606 (0.528–0.682), and 0.885 (0.835–0.927). The pooled rates for PFS at 0.5 years and 1 year were 0.781 (0.688–0.862) and 0.387 (0.293–0.486), respectively. The pooled rates for OS at 1, 2, and 3 years were 0.690 (0.585–0.786), 0.212 (0.117–0.324), and 0.056 (0.028–0.091), respectively. In addition, the pooled rate and 95%CI for the conversion surgery was 0.359 (0.153–0.595). The subgroup analysis of control studies showed that triple therapy was superior to TACE+TKIs, TKIs+ICIs, and TKIs in CR, ORR, and DCR, conversion rate; PFS; and OS. No fatal AEs were reported, and the top three most common AEs were elevated ALT, elevated AST, and hypertension, as well as severe AEs (grading ≥3). Conclusion With the current data, we concluded that the triple therapy of TACE/HAIC, TKIs, and ICIs would provide a clinical benefit for uHCC both in short- and long-term outcomes without increasing severe AEs, but the conclusion needs further validation. Systematic Review Registration http://www.crd.york.ac.uk/PROSPERO/, Review registry: CRD42022321970.
Collapse
Affiliation(s)
- Qiao Ke
- Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China
- College of Clinical Medicine for Oncology, Fujian Medical University, Fuzhou, China
| | - Fuli Xin
- Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China
- College of Clinical Medicine for Oncology, Fujian Medical University, Fuzhou, China
| | - Huipeng Fang
- College of Clinical Medicine for Oncology, Fujian Medical University, Fuzhou, China
| | - Yongyi Zeng
- Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China
- *Correspondence: Yongyi Zeng, ; Lei Wang, ; Jingfeng Liu,
| | - Lei Wang
- College of Clinical Medicine for Oncology, Fujian Medical University, Fuzhou, China
- Department of Radiation Oncology, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, China
- *Correspondence: Yongyi Zeng, ; Lei Wang, ; Jingfeng Liu,
| | - Jingfeng Liu
- Department of Hepatopancreatobiliary Surgery, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, China
- The United Innovation of Mengchao Hepatobiliary Technology Key Laboratory of Fujian Province, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China
- *Correspondence: Yongyi Zeng, ; Lei Wang, ; Jingfeng Liu,
| |
Collapse
|