Hepatic arterial chemotherapy infusion combined with tyrosine kinase inhibitors and PD-1 inhibitors for advanced hepatocellular carcinoma with high risk: a propensity score matching study.

OBJECTIVE

To ascertain the therapeutic efficacy and safety of FOLFOX (oxaliplatin, fluorouracil, and leucovorin)-based hepatic arterial infusion chemotherapy combined with tyrosine kinase inhibitors (TKI) and programmed cell death protein-1 inhibitors (PD-1 inhibitors) (triple therapy), as a first-line treatment in high-risk advanced hepatocellular carcinoma (aHCC with Vp4 portal vein invasion or/and tumor diameter ≥10 cm).

METHODS

This retrospective multicenter study included 466 high-risk aHCC patients treated with either triple therapy ( n =245) or dual therapy (TKI and PD-1 inhibitors, n =221). The overall survival, progression-free survival, objective response rate, and safety were compared between the two groups. Propensity score matching was performed to reduce bias between the two groups.

RESULTS

After propensity score matching (1:1), 194 patients in each group were analyzed. The triple-therapy group showed a longer median overall survival (24.6 vs. 11.9 months; HR=0.43, P <0.001) and a longer median progression-free survival (10.0 vs. 7.7 months; HR=0.68, P =0.002) than the dual-therapy group. The survival rates at 6, 12, and 24 months were 94.2, 71.0, and 50.8% for triple therapy and 75.9, 49.9, and 26.8% for dual therapy. The objective response rate in the triple-therapy group was significantly higher (57.7 vs. 28.9%, P <0.001). In the triple-therapy group, more patients converted to non-high-risk (68.0 vs. 36.6%, P <0.001) and received salvage liver resection or ablation after downstaging conversion (16.5% vs. 9.2%, P =0.033). The grade 3/4 adverse events were 59.2 and 47.4% in the triple-therapy group and dual-therapy group, respectively ( P =0.022).

CONCLUSION

FOLFOX-based hepatic arterial infusion chemotherapy plus TKI and PD-1 inhibitors significantly improve survival prognosis compared with TKI plus PD-1 inhibitors. This is a potential first-line treatment for high-risk aHCC, with a relatively controlled safety profile.