在高肿瘤负荷的不可切除肝细胞癌中，乐伐替尼和替雷利珠单抗对比阿替利珠单抗和贝伐单抗联合经动脉化疗栓塞性肝动脉灌注化疗：一项多中心回顾性队列研究
Lenvatinib and tislelizumab versus atezolizumab and bevacizumab in combination with TAE-HAIC for unresectable hepatocellular carcinoma with high tumor burden: a multicenter retrospective cohort study.
作者信息
Cai Hongjie, Chen Song, Tang Shuangyan, Xiao Yi, Shi Feng, Wu Zhiqiang, Ma Ping, Chen Huanwei, Zhuang Wenquan, Guo Wenbo
机构信息
Department of Interventional Radiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510062, China.
Department of Minimally Invasive Interventional Therapy, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China.
出版信息
Cancer Immunol Immunother. 2025 Feb 1;74(3):88. doi: 10.1007/s00262-025-03942-3.
BACKGROUND
Systemic and locoregional combination therapy has demonstrated promising outcomes for unresectable hepatocellular carcinoma (HCC); However, the best combination option remains unknown. This study compared the efficacy and safety of lenvatinib and tislelizumab versus atezolizumab and bevacizumab in combination with transarterial embolization (TAE) plus hepatic artery infusion chemotherapy (HAIC) for unresectable HCC with high tumor burden.
METHODS
This multicenter retrospective cohort study enrolled treatment-naive patients with unresectable HCC treated with TAE-HAIC plus lenvatinib and tislelizumab (THLP group) or TAE-HAIC plus atezolizumab and bevacizumab (THTA group). The primary endpoint was overall survival (OS). Secondary endpoints included progression-free survival (PFS), tumor response, and adverse events (AEs). Propensity score matching (PSM) was performed to reduce bias.
RESULTS
Of the 240 patients enrolled, 153 and 51 patients were assigned to the THLP and THTA groups, respectively after PSM (3:1). The THLP group showed a longer median OS (22 months vs. 18.2 months; P = 0.412), whereas the median PFS was longer in the THTA group (8.1 months vs. 7 months; P = 0.723), with statistically insignificant intergroup differences. No statistical differences were observed in objective response rate (RECIST 1.1: 33.9 vs. 31.4%; mRECIST: 77.1% vs. 74.5%; P = 0.635), disease control rate (RECIST 1.1: 88.9% vs. 92.2; mRECIST: 92.2% vs. 94.1%; P = 0.716), and in grade 3/4 AEs. Gastrointestinal hemorrhage rate was significantly higher in the THTA group (9.1% vs. 1.6%; P = 0.007). All AEs were controllable and no treatment-related grade 5 AEs occurred.
CONCLUSIONS
TAE-HAIC plus lenvatinib and tislelizumab or TAE-HAIC plus atezolizumab and bevacizumab showed similar outcomes for unresectable HCC with high tumor burden, and manageable safety. The results need further validation.
背景
全身与局部区域联合治疗已在不可切除的肝细胞癌（HCC）中显示出有前景的疗效；然而，最佳联合方案仍不明确。本研究比较了乐伐替尼与替雷利珠单抗联合动脉栓塞化疗（TAE）加肝动脉灌注化疗（HAIC）与阿替利珠单抗和贝伐单抗联合TAE-HAIC治疗高肿瘤负荷不可切除HCC的疗效和安全性。
方法
本多中心回顾性队列研究纳入了未经治疗的不可切除HCC患者，这些患者接受TAE-HAIC联合乐伐替尼和替雷利珠单抗（THLP组）或TAE-HAIC联合阿替利珠单抗和贝伐单抗（THTA组）治疗。主要终点为总生存期（OS）。次要终点包括无进展生存期（PFS）、肿瘤反应和不良事件（AE）。进行倾向评分匹配（PSM）以减少偏倚。
结果
在纳入的240例患者中，PSM后分别有153例和51例患者被分配至THLP组和THTA组（3:1）。THLP组的中位OS更长（22个月对18.2个月；P = 0.412），而THTA组的中位PFS更长（8.1个月对7个月；P = 0.723），组间差异无统计学意义。客观缓解率（RECIST 1.1：33.9%对31.4%；mRECIST：77.1%对74.5%；P = 0.635）、疾病控制率（RECIST 1.1：88.9%对92.2%；mRECIST：92.2%对94.1%；P = 0.716）及3/4级AE方面均未观察到统计学差异。THTA组的胃肠道出血率显著更高（9.1%对1.6%；P = 0.007）。所有AE均可控，未发生与治疗相关的5级AE。
结论
TAE-HAIC联合乐伐替尼和替雷利珠单抗或TAE-HAIC联合阿替利珠单抗和贝伐单抗在高肿瘤负荷不可切除HCC中显示出相似的疗效及可控的安全性。结果需进一步验证。
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