肝动脉灌注化疗联合乐伐替尼和PD - 1抑制剂可改善浸润性肝细胞癌的生存率：一项多中心队列研究
Hepatic Arterial Infusion Chemotherapy Combined Lenvatinib and PD-1 Inhibitor Showed Improved Survival for Infiltrative Hepatocellular Carcinoma: A Multicenter Cohort Study.
作者信息
Li Ruixia, Wang Xiaohui, Li Hui, Wang Murong, Wang Juncheng, Wang Wei, Zhou Qunfang
机构信息
Department of Thyroid Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, People's Republic of China.
Department of Hepatobiliary Surgery, Hunan Provincial People's Hospital, Changsha, Hunan Province, People's Republic of China.
出版信息
J Hepatocell Carcinoma. 2024 Sep 9;11:1727-1740. doi: 10.2147/JHC.S477872. eCollection 2024.
PURPOSE
Lenvatinib and programmed cell death protein-1 (PD-1) inhibitor on infiltrative hepatocellular carcinoma (HCC) have obtained demonstrated efficacy and still need improvement. Hepatic arterial infusion chemotherapy (HAIC) has shown promising results for advanced HCC. This study aimed to compare the efficacy of HAIC combined Lenvatinib and PD-1 inhibitor versus Lenvatinib combined PD-1 inhibitor for infiltrative HCC.
PATIENTS AND METHODS
A total of 232 patients were enrolled. There were 114 patients received Lenvatinib combined PD-1 inhibitor (Len+PD-1 group) and 118 patients received HAIC combined Lenvatinib and PD-1 inhibitor (HAIC+Len+PD-1 group). Overall survival (OS), progression-free survival (PFS) and safety of patients were compared between the two groups by propensity score-matching (PSM).
RESULTS
The 6-, 12-, and 24-month OS rates were 93.8%, 65.1% and 13.4% in Len+PD-1 group, and 100%, 77.3% and 32.1% in HAIC+Len+PD-1 group, respectively. The 3-, 6-, and 12-month PFS rates were 86.4%, 45.7% and 14.1% in Len+PD-1 group, and 95.1%, 59.3% and 25.9% in HAIC+Len+PD-1 group, respectively. The HAIC+Len+PD-1 group had obviously better survival than the Len+PD-1 group both in OS (P=0.002) and PFS (P=0.004). Subgroup analysis revealed that OS in patients with metastasis was improved with HAIC+Len+PD-1 treatment. Patients with alpha-fetoprotein (AFP) response after treatment showed better survival than the non-response. In addition, HAIC+Len+PD-1 group showed manageable adverse events (AEs).
CONCLUSION
Patient with infiltrative HCC, HAIC+Len+PD-1 treatment had longer OS and PFS than Len+PD-1 treatment. Early AFP response was an effective indicator of better survival and tumor response to therapy.
目的
乐伐替尼与程序性细胞死亡蛋白1（PD-1）抑制剂联合用于浸润性肝细胞癌（HCC）已显示出疗效，但仍需改进。肝动脉灌注化疗（HAIC）对晚期HCC已显示出有前景的结果。本研究旨在比较HAIC联合乐伐替尼与PD-1抑制剂和乐伐替尼联合PD-1抑制剂治疗浸润性HCC的疗效。
患者与方法
共纳入232例患者。114例患者接受乐伐替尼联合PD-1抑制剂治疗（乐伐替尼+PD-1组），118例患者接受HAIC联合乐伐替尼与PD-1抑制剂治疗（HAIC+乐伐替尼+PD-1组）。通过倾向得分匹配（PSM）比较两组患者的总生存期（OS）、无进展生存期（PFS）和安全性。
结果
乐伐替尼+PD-1组6个月、12个月和24个月的OS率分别为93.8%、65.1%和13.4%，HAIC+乐伐替尼+PD-1组分别为100%、77.3%和32.1%。乐伐替尼+PD-1组3个月、6个月和12个月的PFS率分别为86.4%、45.7%和14.1%，HAIC+乐伐替尼+PD-1组分别为95.1%、59.3%和25.9%。HAIC+乐伐替尼+PD-1组在OS（P=0.002）和PFS（P=0.004）方面的生存期均明显优于乐伐替尼+PD-1组。亚组分析显示，HAIC+乐伐替尼+PD-1治疗可改善转移患者的OS。治疗后甲胎蛋白（AFP）有反应的患者生存期优于无反应者。此外，HAIC+乐伐替尼+PD-1组的不良事件（AE）可控。
结论
浸润性HCC患者，HAIC+乐伐替尼+PD-1治疗的OS和PFS比乐伐替尼+PD-1治疗更长。早期AFP反应是生存期更好及肿瘤对治疗有反应的有效指标。
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