Chen Ruiqing, Li Ye, Song Ke, Li Lingbing, Shen Chenyu, Ma Pengkai, Wang Zhijun
Department of Interventional Radiology, The First Medical Center, Chinese PLA General Hospital, Beijing, China.
Department of Interventional Radiology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, China.
J Gastrointest Oncol. 2022 Apr;13(2):780-786. doi: 10.21037/jgo-22-239.
The efficacy of transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT) is limited. There are insufficient data on TACE-lenvatinib sequential therapy for HCC with PVTT. We aimed to assess the efficacy and safety of TACE-lenvatinib sequential therapy for the treatment of HCC and PVTT.
We retrospectively reviewed 12 consecutive patients with HCC and PVTT who underwent TACE-lenvatinib sequential therapy between July 2018 and May 2021. Lenvatinib treatment was started 1 week after TACE at a dose of 8 or 12 mg daily depending on the patient weight. Follow-up examinations were performed at 4 week and then every 8 weeks after the first TACE procedure. Overall survival (OS), progression-free survival (PFS), objective response rate (ORR), disease control rate (DCR) and adverse events (AEs) were calculated. Survival curves of PFS and OS were estimated using the Kaplan-Meier method.
The median OS and PFS were 16.9 and 6.15 months, respectively. The ORR and DCR were 75% and 91.7%, respectively. The most common lenvatinib-related AE was hypertension (33.3%), and the most common TACE-related AE was elevated liver enzymes (100%). No treatment-related deaths or grade 4 events were observed.
TACE-lenvatinib sequential therapy may be safe and well tolerated, and may improve OS and PFS for HCC patients with PVTT. Further randomized controlled trials with larger cohorts are needed to confirm its efficacy and safety.
经动脉化疗栓塞术（TACE）治疗伴有门静脉癌栓（PVTT）的肝细胞癌（HCC）疗效有限。关于TACE-乐伐替尼序贯疗法治疗伴有PVTT的HCC的数据不足。我们旨在评估TACE-乐伐替尼序贯疗法治疗HCC和PVTT的疗效及安全性。
我们回顾性分析了2018年7月至2021年5月期间连续接受TACE-乐伐替尼序贯疗法的12例伴有PVTT的HCC患者。TACE术后1周开始服用乐伐替尼，根据患者体重，每日剂量为8或12mg。首次TACE术后4周进行随访检查，之后每8周进行一次。计算总生存期（OS）、无进展生存期（PFS）、客观缓解率（ORR）、疾病控制率（DCR）及不良事件（AE）。采用Kaplan-Meier法估计PFS和OS的生存曲线。
中位OS和PFS分别为16.9个月和6.15个月。ORR和DCR分别为75%和91.7%。最常见的与乐伐替尼相关的AE是高血压（33.3%），最常见的与TACE相关的AE是肝酶升高（100%）。未观察到与治疗相关的死亡或4级事件。
TACE-乐伐替尼序贯疗法可能安全且耐受性良好，可能改善伴有PVTT的HCC患者的OS和PFS。需要进一步开展更大样本量的随机对照试验以证实其疗效和安全性。
