Efficiency and Safety of HAIC Combined with Lenvatinib and PD-1 Inhibitor for Advanced Hepatocellular Carcinoma with Lung Metastasis: A Multicenter Propensity Score Matching Analysis.

PURPOSE

This study aimed to evaluate the clinical efficiency and safety of hepatic arterial infusion chemotherapy (HAIC) combined with lenvatinib and programmed cell death protein-1 (PD-1) inhibitor for patients with hepatocellular carcinoma (HCC) and lung metastasis.

METHODS

In this multicenter retrospective study, treatment-naive patients with advanced (BCLC stage C) HCC and lung metastases who received lenvatinib and PD-1 inhibitor - with or without HAIC - between January 2019 and January 2024 were reviewed. Propensity score matching (PSM) was applied to balance baseline characteristics between the two groups. The primary endpoint was overall survival (OS). Secondary endpoints included progression-free survival (PFS), objective response rate (ORR), and disease control rate (DCR) according to RECIST 1.1 criteria, as well as adverse events (AEs).

RESULTS

A total of 422 eligible patients were included, with 169 receiving HAIC (HLP group) and 253 receiving lenvatinib plus PD-1 inhibitor (LP group). After 1:1 PSM, 151 patients were matched in each group. The HLP group demonstrated significantly longer median OS compared to the LP group (26.0 8.4 months; hazard ratio [HR]: 0.36; 95% confidence interval [CI]: 0.27-0.49; < 0.001). Median PFS was also improved in the HLP group (7.6 5.5 months; HR: 0.77; 95% CI: 0.59-1.00; = 0.048). ORR and DCR were significantly higher in the HLP group (ORR: 47.7% 20.5%, < 0.001; DCR: 86.1% 72.2%, = 0.003). Although the HLP group experienced a higher incidence of both all-grade and grade 3/4 AEs, all were manageable, and no grade 5 events occurred.

CONCLUSION

HAIC combined with lenvatinib and PD-1 inhibitor shows promise as a treatment for advanced HCC with lung metastases, offering improved prognosis and a manageable safety profile.