Department of Minimally Invasive Interventional Radiology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, 510060, People's Republic of China.
State Key Laboratory of Oncology in South China, Guangzhou, People's Republic of China.
Cancer Immunol Immunother. 2024 Nov 14;74(1):24. doi: 10.1007/s00262-024-03872-6.
The goal of this study was to compare the efficacy and safety of hepatic arterial infusion chemotherapy (HAIC) combined with targeted therapy and PD-(L)1 blockade (triple therapy), either sequentially (SE) or simultaneously (SI), in the treatment of Barcelona Clinic Liver Cancer (BCLC) stage C hepatocellular carcinoma (HCC).
From January 1, 2018, to June 1, 2022, 575 patients with BCLC stage C HCC who underwent SE or SI triple therapy were retrospectively enrolled. Propensity score matching (PSM; 1:1) was performed to eliminate possible confounder imbalances across cohorts. We used the Kaplan-Meier method and a log-rank test to compare the overall survival (OS) and progression-free survival (PFS) rates between the SI and SE groups. The tumor response and the incidence of adverse events (AEs) were reported. After PSM, 182 patients in each of the two groups were matched. The median OS in the SI group was significantly longer than that in the SE group (28.8 vs. 16.1 months; P = 0.002), and the median PFS was significantly improved in the SI versus SE group (9.6 vs. 7.0 months; P = 0.01). The objective response rate based on the mRECIST was higher in the SI group (58% vs. 37%; P < 0.001). The total incidences of grade 3-4 AEs were 111/182 (60.9%) and 128/182 (70.3%) in the SE and SI groups, respectively. No grade 5 AEs were reported in either group.
Simultaneous HAIC plus targeted therapy and PD-(L)1 blockade significantly improved outcomes compared to the sequential regimen in patients with BCLC stage C HCC, with no unexpected AEs.
The patients who received hepatic arterial infusion chemotherapy combined with targeted therapy and PD-(L)1 blockade simultaneously have a better prognosis than those who received it sequentially.
本研究旨在比较经肝动脉化疗灌注（HAIC）联合靶向治疗和 PD-(L)1 阻断（三联疗法）序贯（SE）和同步（SI）治疗巴塞罗那临床肝癌（BCLC）C 期肝细胞癌（HCC）的疗效和安全性。
本研究回顾性纳入 2018 年 1 月 1 日至 2022 年 6 月 1 日接受 SE 或 SI 三联疗法的 575 例 BCLC C 期 HCC 患者。采用倾向性评分匹配（PSM；1:1）消除队列间可能的混杂因素不平衡。采用 Kaplan-Meier 法和对数秩检验比较 SI 和 SE 组的总生存期（OS）和无进展生存期（PFS）率。报告肿瘤反应和不良事件（AE）的发生率。PSM 后，两组各匹配 182 例患者。SI 组的中位 OS 明显长于 SE 组（28.8 个月比 16.1 个月；P=0.002），SI 组的中位 PFS 明显长于 SE 组（9.6 个月比 7.0 个月；P=0.01）。SI 组的客观缓解率（mRECIST）更高（58%比 37%；P<0.001）。SE 组和 SI 组的 3-4 级 AE 总发生率分别为 111/182（60.9%）和 128/182（70.3%）。两组均未报告 5 级 AE。
与序贯方案相比，BCLC C 期 HCC 患者同时接受 HAIC 联合靶向治疗和 PD-(L)1 阻断治疗可显著改善预后，且无意外 AE。
同时接受肝动脉化疗灌注联合靶向治疗和 PD-(L)1 阻断治疗的患者比序贯治疗的患者预后更好。
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