Terashima Takeshi, Yamamoto Makoto, Toyama Tadashi, Kido Hidenori, Takata Noboru, Hayashi Tomoyuki, Seki Akihiro, Nakagawa Hidetoshi, Nio Kouki, Iida Noriho, Yamada Shinya, Shimakami Tetsuro, Takatori Hajime, Mizukoshi Eishiro, Honda Masao, Yamashita Taro
Department of Gastroenterology, Kanazawa University Hospital, Kanazawa, Japan.
Department of Medical Oncology, Kanazawa Medical University, Kanazawa, Japan.
Hepatol Res. 2025 Apr 9. doi: 10.1111/hepr.14194.
Combination therapy with lenvatinib and hepatic arterial infusion chemotherapy (HAIC) using cisplatin had a high antitumor effect for advanced hepatocellular carcinoma (HCC); however, the efficacy of adding HAIC using cisplatin to lenvatinib remains unclear.
We retrospectively reviewed the charts of advanced HCC patients who were treated with lenvatinib or lenvatinib plus HAIC using cisplatin and compared the efficacy between them. The patients received 12 mg or 8 mg of lenvatinib once daily by weight in both groups, and 65 mg/m of cisplatin through the hepatic artery every 4 weeks in the lenvatinib plus HAIC group.
A total of 140 patients were included in this analysis, with 40 patients in each of the lenvatinib group and lenvatinib plus HAIC groups selected through propensity score matching analysis. Objective response rate (20.0 vs. 67.5%, p < 0.001), progression-free survival (median 4.6 vs. 9.2 months, p = 0.032), and overall survival (median 12.1 vs. 20.6 months, p = 0.024) for the lenvatinib plus HAIC group were significantly better compared with those for the lenvatinib group. Subgroup analysis suggested a greater prognostic benefit in patients with larger tumor size, vascular invasion, and those with prior treatment with immune checkpoint inhibitors. Although the main grade 3-4 adverse events more frequently observed in the lenvatinib plus HAIC group were hematological toxicities, all were manageable.
Adding HAIC using cisplatin to lenvatinib improved the response to treatment and outcome for advanced HCC patients. Further studies are needed to confirm these results and explore the clinical positioning of lenvatinib plus HAIC.
乐伐替尼与使用顺铂的肝动脉灌注化疗（HAIC）联合治疗对晚期肝细胞癌（HCC）具有较高的抗肿瘤效果；然而，在乐伐替尼基础上加用顺铂进行HAIC的疗效仍不明确。
我们回顾性分析了接受乐伐替尼或乐伐替尼联合顺铂HAIC治疗的晚期HCC患者的病历，并比较了两组之间的疗效。两组患者均根据体重每日一次接受12mg或8mg乐伐替尼治疗，乐伐替尼联合HAIC组每4周通过肝动脉给予65mg/m²顺铂。
本分析共纳入140例患者，通过倾向评分匹配分析在乐伐替尼组和乐伐替尼联合HAIC组各选择了40例患者。乐伐替尼联合HAIC组的客观缓解率（20.0%对67.5%，p<0.001）、无进展生存期（中位数4.6个月对9.2个月，p=0.032）和总生存期（中位数12.1个月对20.6个月，p=0.024）均显著优于乐伐替尼组。亚组分析表明，肿瘤体积较大、有血管侵犯以及既往接受过免疫检查点抑制剂治疗的患者预后获益更大。尽管乐伐替尼联合HAIC组更常观察到的主要3-4级不良事件是血液学毒性，但所有这些毒性都是可控的。
在乐伐替尼基础上加用顺铂进行HAIC可改善晚期HCC患者的治疗反应和预后。需要进一步研究来证实这些结果并探索乐伐替尼联合HAIC的临床定位。
