Drug-eluting beads chemoembolization combined with programmed cell death 1 inhibitor and lenvatinib for large hepatocellular carcinoma

Abstract

BACKGROUND

The combination of transarterial chemoembolization (TACE), lenvatinib, and programmed cell death 1 (PD-1) inhibitor has been widely used in the treatment of advanced hepatocellular carcinoma (HCC) and has achieved promising results. However, there are few studies comparing whether drug-eluting beads TACE (D-TACE) can bring more survival benefits to patients with large HCC compared to conventional TACE (C-TACE) in this triplet therapy.

AIM

To compare the efficacy and adverse events (AEs) of triple therapy comprising D-TACE, PD-1 inhibitors, and lenvatinib (D-TACE-P-L) and C-TACE, PD-1 inhibitors, and lenvatinib (C-TACE-P-L) in patients with large HCC (maximum diameter ≥ 5 cm), and analyze the prognostic factors.

METHODS

Following a comprehensive review of our hospital’s medical records, this retrospective study included 104 patients: 50 received D-TACE-P-L, and 54 received C-TACE-P-L. We employed Kaplan-Meier estimation to assess the median progression-free survival (PFS) between the two groups, utilized Cox multivariate regression analysis to identify prognostic factors, and applied the χ² test to evaluate AEs.

RESULTS

The objective response rate (ORR) and median PFS were significantly higher in the D-TACE-P-L group compared to the C-TACE-P-L group (ORR: 66.0% vs 44.4%, P = 0.027; median PFS: 6.8 months vs 5.0 months, P = 0.041). Cox regression analysis identified treatment option, portal vein tumor thrombus, and hepatic vein invasion as protective factors for PFS. AEs were comparable between the two groups.

CONCLUSION

D-TACE-P-L may have significantly better PFS and ORR for large HCC, while exhibiting similar AEs to C-TACE-P-L.

Keywords: Large hepatocellular carcinoma; Conventional transarterial chemoembolization; Drug-eluting beads transarterial chemoembolization; Programmed cell death 1 inhibitor; Lenvatinib

Core Tip: A retrospective analysis encompassing 104 patients diagnosed with large hepatocellular carcinoma (≥ 5 cm), focused on comparing the efficacy and safety of two treatment modalities, which were the triple combination therapy of drug-eluting beads transarterial chemoembolization (D-TACE), programmed cell death 1 inhibitor, and lenvatinib (D-TACE-P-L) and the triple therapy consisting of conventional TACE, programmed cell death protein 1 inhibitor, and lenvatinib. Progression-free survival, tumor response, and adverse events were compared between the two groups, and the findings revealed that D-TACE-P-L demonstrated significantly superior median progression-free survival and objective response rate, while maintaining comparable toxicity profiles. Based on these outcomes, this study proposed that the D-TACE-P-L therapy served as a preferential treatment option for individuals suffering from large hepatocellular carcinoma.