Tan Bin-Bin, Fu Ying, Shao Ming-Hua, Chen Hai-Lei, Liu Ping, Fan Chao, Zhang Hui
Department of Hepatobiliary Surgery, First Affiliated Hospital of Third Military Medical University (Army Medical University), Chongqing 400038, China.
Department of Hepatobiliary Surgery, First Affiliated Hospital of Third Military Medical University (Army Medical University), Jiangbei Area (The 958 Hospital of Chinese People's Liberation Army), Chongqing 400020, China.
World J Gastrointest Surg. 2024 Sep 27;16(9):2829-2841. doi: 10.4240/wjgs.v16.i9.2829.
Hepatocellular carcinoma (HCC) often presents as unresectable, necessitating effective treatment modalities. Combining transarterial chemoembolization (TACE) with immunotherapy and targeted therapy has shown promise, yet real-world evidence is needed.
To investigate effectiveness and safety of TACE with tislelizumab ± targeted therapy for unresectable HCC in real-world setting.
This retrospective study included patients with unresectable HCC receiving combined treatment of TACE and tislelizumab. The clinical outcomes included progression-free survival (PFS), overall survival (OS), objective response rate (ORR), and disease control rate (DCR). All patients were evaluated according to the mRECIST criteria. The adverse event (AE) was also assessed.
In this study of 56 patients with median follow-up of 10.9 months, 7 had previous immunotherapy. Tislelizumab was administered before TACE in 21 (37.50%) and after in 35 (62.50%) patients, with 91.07% receiving concurrent targeted therapy. Median PFS was 14.0 (95%CI: 7.0-18.00) months, and OS was 28 (95%CI: 2.94-53.05) months. Patients with prior immunotherapy had shorter PFS (6 vs. 18 months, = 0.006). Overall ORR and DCR were 82.14% and 87.50%. Grade ≥ 3 treatment-related AEs included increased alanine aminotransferase (8.93%), aspartate aminotransferase (10.71%), and total bilirubin (3.57%).
The combination of TACE and tislelizumab, with or without targeted therapy, demonstrated promising efficacy and safety in unresectable HCC, especially in immunotherapy-naive patients, warranting further prospective validation studies.
肝细胞癌（HCC）常表现为不可切除，因此需要有效的治疗方式。经动脉化疗栓塞术（TACE）与免疫疗法及靶向疗法联合应用已显示出前景，但仍需要真实世界的证据。
在真实世界环境中研究TACE联合替雷利珠单抗±靶向疗法治疗不可切除HCC的有效性和安全性。
这项回顾性研究纳入了接受TACE与替雷利珠单抗联合治疗的不可切除HCC患者。临床结局包括无进展生存期（PFS）、总生存期（OS）、客观缓解率（ORR）和疾病控制率（DCR）。所有患者均根据mRECIST标准进行评估。同时对不良事件（AE）进行评估。
在这项对56例患者进行的研究中，中位随访时间为10.9个月，7例患者曾接受过免疫治疗。21例（37.50%）患者在TACE之前接受替雷利珠单抗治疗，35例（62.50%）患者在TACE之后接受治疗，91.07%的患者接受了同步靶向治疗。中位PFS为14.0（95%CI：7.0 - 18.00）个月，OS为28（95%CI：2.94 - 53.05）个月。曾接受免疫治疗的患者PFS较短（6个月对18个月，P = 0.006）。总体ORR和DCR分别为82.14%和87.50%。≥3级治疗相关不良事件包括丙氨酸氨基转移酶升高（8.93%）、天冬氨酸氨基转移酶升高（10.71%）和总胆红素升高（3.57%）。
TACE与替雷利珠单抗联合应用，无论是否联合靶向疗法，在不可切除HCC中均显示出有前景的疗效和安全性，尤其是在未接受过免疫治疗的患者中，值得进一步开展前瞻性验证研究。
