肝动脉灌注化疗联合仑伐替尼和替雷利珠单抗，联合或不联合经肝动脉栓塞术治疗伴有门静脉瘤栓和高肿瘤负荷的不可切除肝细胞癌：一项多中心回顾性研究
Hepatic Arterial Infusion Chemotherapy Plus Lenvatinib and Tislelizumab with or Without Transhepatic Arterial Embolization for Unresectable Hepatocellular Carcinoma with Portal Vein Tumor Thrombus and High Tumor Burden: A Multicenter Retrospective Study.
作者信息
Chen Song, Shi Feng, Wu Zhiqiang, Wang Liguang, Cai Hongjie, Ma Ping, Zhou Yuanmin, Mai Qicong, Wang Fan, Tang Shuangyan, Zhuang Wenquan, Lai Jiaming, Chen Xiaoming, Chen Huanwei, Guo Wenbo
机构信息
Department of Minimally Invasive Interventional Therapy, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China.
Department of Interventional Radiology, Guangdong Provincial People's Hospital, Guangzhou, People's Republic of China.
出版信息
J Hepatocell Carcinoma. 2023 Jul 27;10:1209-1222. doi: 10.2147/JHC.S417550. eCollection 2023.
PURPOSE
The current therapeutic strategies for high-risk, unresectable hepatocellular carcinoma (HCC) patients demonstrate suboptimal outcomes. This study aimed to assess the clinical efficacy of the combined approach of hepatic arterial infusion chemotherapy (HAIC), lenvatinib, and tislelizumab, either with or without transhepatic arterial embolization (TAE), in managing HCC patients with portal vein tumor thrombus (PVTT) and significant tumor load.
PATIENTS AND METHODS
In this multicenter retrospective study, we analyzed patients diagnosed with primary, unresectable HCC presenting with PVTT and substantial tumor load who had undergone treatment with HAIC, lenvatinib, and tislelizumab, with or without TAE (referred to as the THLP or HLP group), between January 2019 and February 2022 across four medical centers in China. The outcomes included objective response rate (ORR), disease control rate (DCR), overall survival (OS), and progression-free survival (PFS).
RESULTS
The study cohort comprised 100 patients, 50 each in the THLP and HLP groups. The THLP group demonstrated a significantly superior ORR (72% vs 52%, =0.039). However, both groups exhibited comparable DCR (88% vs 76%, =0.118), as assessed by the modified response evaluation criteria in solid tumors. The median OS and PFS for the entire cohort were 12.5 months (95% CI, 10.9-14.8) and 5.0 months (95% CI, 4.2-5.4), respectively. The THLP group exhibited a significantly extended OS (median, 14.1 vs 11.3 months, =0.041) and PFS (median, 5.6 vs 4.4 months, =0.037) in comparison to the HLP group. The most frequently reported treatment-related adverse events included abdominal pain and nausea, both reported by 59% of patients.
CONCLUSION
The combination of HAIC, lenvatinib, tislelizumab, and TAE was feasible in HCC patients with PVTT and high tumor burden, with tolerable safety.
目的
目前针对高危、不可切除肝细胞癌（HCC）患者的治疗策略效果欠佳。本研究旨在评估肝动脉灌注化疗（HAIC）、仑伐替尼和替雷利珠单抗联合应用（无论是否联合经肝动脉栓塞术（TAE））在治疗伴有门静脉癌栓（PVTT）和显著肿瘤负荷的HCC患者中的临床疗效。
患者与方法
在这项多中心回顾性研究中，我们分析了2019年1月至2022年2月期间在中国四个医疗中心接受HAIC、仑伐替尼和替雷利珠单抗治疗（无论是否联合TAE，称为THLP或HLP组）的原发性、不可切除HCC伴PVTT和大量肿瘤负荷的患者。观察指标包括客观缓解率（ORR）、疾病控制率（DCR）、总生存期（OS）和无进展生存期（PFS）。
结果
研究队列包括100例患者，THLP组和HLP组各50例。THLP组的ORR显著更高（72%对52%，P=0.039）。然而，根据实体瘤改良疗效评价标准评估，两组的DCR相当（88%对76%，P=0.118）。整个队列的中位OS和PFS分别为12.5个月（95%CI，10.9 - 14.8）和5.0个月（95%CI，4.2 - 5.4）。与HLP组相比，THLP组的OS（中位，14.1对11.3个月，P=0.041）和PFS（中位，5.6对4.4个月，P=0.037）显著延长。最常报告的与治疗相关的不良事件包括腹痛和恶心，均有59%的患者报告。
结论
HAIC、仑伐替尼、替雷利珠单抗和TAE联合应用于伴有PVTT和高肿瘤负荷的HCC患者是可行的，安全性可耐受。
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