Published online Apr 15, 2024. doi: 10.4251/wjgo.v16.i4.1236
Peer-review started: October 4, 2023
First decision: December 18, 2023
Revised: December 29, 2023
Accepted: February 18, 2024
Article in press: February 18, 2024
Published online: April 15, 2024
Processing time: 189 Days and 12.9 Hours
Transarterial chemoembolization (TACE) is the standard locoregional therapy for unresectable hepatocellular carcinoma (HCC), but not every patient can benefit from TACE, and there is also relatively high post-TACE recurrence. Triple therapy with TACE combined with lenvatinib plus PD-1 inhibitors, may result in a better prognosis for HCC patients.
The efficacy and safety of this triple therapy have been rarely evaluated and it is unknown which factors are related to efficacy. By solving this problem, this will aid clinical decision-making.
In this study, we aimed to first assess the efficacy and safety of TACE-lenvatinib-PD1 therapy for unresectable HCC patients and to explore the predictive factors of clinical outcomes.
During follow-up, tumor responses were assessed based on the modified Response Evaluation Criteria in Solid Tumors and categorized as complete response, partial response, stable disease, or progression disease. The objective response rate (ORR), disease control rate (DCR), overall survival (OS), and progression-free survival (PFS) were also calculated. The Cox proportional hazards regression method was used to identify the factors associated with OS and PFS.
The confirmed ORR was 61.76% (63/102), and the DCR was 81.37% (83/102). The median PFS was 10.07 months (95%CI: 8.50-11.65), and the median OS was 26.43 months (95%CI: 17.00-35.87). Barcelona Clinic Liver Cancer Classification (BCLC) B stage, early neutrophil-to-lymphocyte ratio (NLR) response (decrease) and early AFP response (decrease > 20%) were identified as the independent predictors of clinical outcomes.
This study showed that TACE-lenvatinib-PD-1 treatment was well tolerated with encouraging efficacy in unresectable HCC patients. The patients with BCLC B, with early NLR response (decrease) and early AFP response (decrease > 20%) might achieve better clinical outcomes with this triple therapy.
Further prospective studies with larger sample sizes are necessary. In addition, subgroup analyses are needed to determine the unknown differences attributing to each agent.