Xue Miao, Wu Yanqin, Zhu Bowen, Zou Xinhua, Fan Wenzhe, Li Jiaping
Department of Interventional Oncology, The First Affiliated Hospital of Sun Yat-sen University Guangzhou 510080, Guangdong, China.
Am J Cancer Res. 2021 Dec 15;11(12):6107-6118. eCollection 2021.
Recently, a prospective randomized study suggested that transcatheter arterial chemoembolization (TACE) plus lenvatinib, as opposed to TACE plus sorafenib, was an effective and promising treatment for patients with advanced hepatocellular carcinoma (HCC) having portal vein thrombus (PVTT) and large tumor burden. However, no propensity score matching retrospective studies on TACE with drug-eluting beads (DEB-TACE) plus lenvatinib (DEB-TACE+LEN) versus DEB-TACE plus sorafenib (DEB-TACE+SOR) for advanced HCC has been reported to date. The medical records of consecutive patients with advanced HCC who underwent DEB-TACE+LEN or DEB-TACE+SOR between January 2017 and December 2020 were retrospectively reviewed. Mutation genes (VEGF, ANG2, FGF19, FGF21, and FGF23) were measured by whole-exome sequencing (WES). Adverse events (AEs), objective response rate (ORR), disease control rate (DCR), overall survival (OS) and time to progression (TTP) were compared between patients who underwent DEB-TACE+LEN and DEB-TACE+SOR. In total, 150 patients were enrolled in this study. The DEB-TACE+LEN group (n=50) showed significantly better ORR (64.0% vs. 33.3%; =0.008), OS (hazard ratio [HR]=0.63, 95% confidence interval (CI): 0.41-0.98; =0.043), and TTP (HR=0.65, 95% CI: 0.45-0.94; =0.023) than that in the DEB-TACE+SOR group (n=100). Subgroup analyses showed that in patients with portal vein tumor thrombus (PVTT), OS and TTP were significantly longer in the DEB-TACE+LEN group than in the DEB-TACE+SOR group (HR=0.59, 95% CI: 0.36-0.98; =0.043; HR=0.89, 95% CI: 0.35-2.29; =0.035). In patients with FGF21 amplification, OS was also significantly longer in the DEB-TACE+LEN group than that in the DEB-TACE+SOR group (HR=0.19, 95% CI: 0.06-0.66; =0.003). The patients in DEB-TACE+LEN group had a significantly lower incidence of hand-foot skin reaction (32.0% vs. 49.0%; =0.048), but a higher incidence of proteinuria (26.0% vs. 10.0%; =0.010) than that in the DEB-TACE+SOR group. In conclusion, DEB-TACE+LEN conferred better ORR, OS and TTP than did DEB-TACE+SOR in patients with advanced HCC, especially those with PVTT and FGF21 amplification, with acceptable AEs; thus making it a superior treatment modality for these patients.
最近，一项前瞻性随机研究表明，对于患有门静脉血栓形成（PVTT）和大肿瘤负荷的晚期肝细胞癌（HCC）患者，经动脉化疗栓塞术（TACE）联合乐伐替尼，与TACE联合索拉非尼相比，是一种有效且有前景的治疗方法。然而，迄今为止，尚未有关于药物洗脱微球TACE（DEB-TACE）联合乐伐替尼（DEB-TACE+LEN）与DEB-TACE联合索拉非尼（DEB-TACE+SOR）治疗晚期HCC的倾向评分匹配回顾性研究报道。对2017年1月至2020年12月期间接受DEB-TACE+LEN或DEB-TACE+SOR治疗的连续晚期HCC患者的病历进行回顾性分析。通过全外显子测序（WES）检测突变基因（VEGF、ANG2、FGF19、FGF21和FGF23）。比较接受DEB-TACE+LEN和DEB-TACE+SOR治疗的患者的不良事件（AE）、客观缓解率（ORR）、疾病控制率（DCR）、总生存期（OS）和疾病进展时间（TTP）。本研究共纳入150例患者。DEB-TACE+LEN组（n=50）的ORR（64.0%对33.3%；P=0.008）、OS（风险比[HR]=0.63，95%置信区间（CI）：0.41-0.98；P=0.043）和TTP（HR=0.65，95%CI：0.45-0.94；P=0.023）均显著优于DEB-TACE+SOR组（n=100）。亚组分析显示，在门静脉肿瘤血栓（PVTT）患者中，DEB-TACE+LEN组的OS和TTP显著长于DEB-TACE+SOR组（HR=0.59，95%CI：0.36-0.98；P=0.043；HR=0.89，95%CI：0.35-2.29；P=0.035）。在FGF21扩增患者中，DEB-TACE+LEN组的OS也显著长于DEB-TACE+SOR组（HR=0.19，95%CI：0.06-0.
