HAIC Plus Lenvatinib and Tislelizumab for Advanced Hepatocellular Carcinoma with Vp4 Portal Vein Invasion

Overview

Journal Hepatol Int

Publisher Springer

Date 2025 Jan 9

PMID 39786672

Authors

Shuangyan Tang

Feng Shi

Yi Xiao

Hongjie Cai

Ping Ma

Yuanmin Zhou

Zhiqiang Wu

Song Chen

Wenbo Guo

Affiliations

Soon will be listed here.

Abstract

Background/objective: The treatment strategy for hepatocellular carcinoma (HCC) with Vp4 (main trunk) portal vein tumor thrombosis (PVTT) remains controversial due to the dismal prognosis. We aimed to investigate the efficacy and safety of hepatic arterial infusion chemotherapy (HAIC) plus lenvatinib and tislelizumab in these patients.

Methods: This multicenter retrospective study included treatment-naive HCC patients with Vp4 PVTT from 2017 to 2022. They were treated with HAIC plus lenvatinib and tislelizumab (HLP group) or HAIC alone (HAIC group). Overall survival (OS), progression-free survival (PFS), objective response rate (ORR), and adverse events (AEs) were assessed. Propensity score matching (PSM) was performed to reduce bias.

Results: In this study, 155 HCC patients with Vp4 PVTT were included, with 38 in the HLP group and 117 in the HAIC group, with 35 per group matched by PSM. The HLP group showed longer median OS (23.2 vs. 6.9 months; HR 0.333, p < 0.001) and PFS (6.6 vs. 2.4 months; HR 0.403, p = 0.002) than the HAIC group. Higher ORR for tumor (77.1% vs. 42.9%, p = 0.003) and PVTT (51.4% vs. 22.9%, p = 0.025) was observed in the HLP group. More patients underwent hepatectomy post-conversion therapy (15.8% vs. 0.9%). Grade 3/4 AEs were higher in the HLP group (47.4% vs. 35.0%), but there was no significant difference, and no grade 5 AEs occurred in either group.

Conclusions: HAIC combined with lenvatinib and tislelizumab may be a promising treatment in patients with HCC and Vp4 PVTT because of the improved prognosis and acceptable safety profile.

References

Ogren M, Bergqvist D, Bjorck M, Acosta S, Eriksson H, Sternby N . Portal vein thrombosis: prevalence, patient characteristics and lifetime risk: a population study based on 23,796 consecutive autopsies. World J Gastroenterol. 2006; 12(13):2115-9. PMC: 4087695. DOI: 10.3748/wjg.v12.i13.2115. View

Soin A, Lesurtel M, Bhangui P, Cocchi L, Bouattour M, Clavien P . Are patients with hepatocellular carcinoma and portal vein tumour thrombosis candidates for liver transplantation?. J Hepatol. 2023; 78(6):1124-1129. DOI: 10.1016/j.jhep.2023.03.032. View

Nakazawa T, Hidaka H, Shibuya A, Okuwaki Y, Tanaka Y, Takada J . Overall survival in response to sorafenib versus radiotherapy in unresectable hepatocellular carcinoma with major portal vein tumor thrombosis: propensity score analysis. BMC Gastroenterol. 2014; 14:84. PMC: 4014748. DOI: 10.1186/1471-230X-14-84. View

Qin S, Ren Z, Feng Y, Yau T, Wang B, Zhao H . Atezolizumab plus Bevacizumab versus Sorafenib in the Chinese Subpopulation with Unresectable Hepatocellular Carcinoma: Phase 3 Randomized, Open-Label IMbrave150 Study. Liver Cancer. 2021; 10(4):296-308. PMC: 8339481. DOI: 10.1159/000513486. View

Cappuyns S, Corbett V, Yarchoan M, Finn R, Llovet J . Critical Appraisal of Guideline Recommendations on Systemic Therapies for Advanced Hepatocellular Carcinoma: A Review. JAMA Oncol. 2023; 10(3):395-404. PMC: 10837331. DOI: 10.1001/jamaoncol.2023.2677. View

Iwamoto H, Shimose S, Shirono T, Niizeki T, Kawaguchi T . Hepatic arterial infusion chemotherapy for advanced hepatocellular carcinoma in the era of chemo-diversity. Clin Mol Hepatol. 2023; 29(3):593-604. PMC: 10366803. DOI: 10.3350/cmh.2022.0391. View

Zhao M, Guo Z, Zou Y, Li X, Yan Z, Chen M . Arterial chemotherapy for hepatocellular carcinoma in China: consensus recommendations. Hepatol Int. 2023; 18(1):4-31. DOI: 10.1007/s12072-023-10599-6. View

Lyu N, Wang X, Li J, Lai J, Chen Q, Li S . Arterial Chemotherapy of Oxaliplatin Plus Fluorouracil Versus Sorafenib in Advanced Hepatocellular Carcinoma: A Biomolecular Exploratory, Randomized, Phase III Trial (FOHAIC-1). J Clin Oncol. 2021; 40(5):468-480. DOI: 10.1200/JCO.21.01963. View

Xie D, Zhu K, Ren Z, Zhou J, Fan J, Gao Q . A review of 2022 Chinese clinical guidelines on the management of hepatocellular carcinoma: updates and insights. Hepatobiliary Surg Nutr. 2023; 12(2):216-228. PMC: 10129899. DOI: 10.21037/hbsn-22-469. View

10.

Sun J, Guo R, Bi X, Wu M, Tang Z, Lau W . Guidelines for Diagnosis and Treatment of Hepatocellular Carcinoma with Portal Vein Tumor Thrombus in China (2021 Edition). Liver Cancer. 2022; 11(4):315-328. PMC: 9294940. DOI: 10.1159/000523997. View

11.

He M, Li Q, Zou R, Shen J, Fang W, Tan G . Sorafenib Plus Hepatic Arterial Infusion of Oxaliplatin, Fluorouracil, and Leucovorin vs Sorafenib Alone for Hepatocellular Carcinoma With Portal Vein Invasion: A Randomized Clinical Trial. JAMA Oncol. 2019; 5(7):953-960. PMC: 6512278. DOI: 10.1001/jamaoncol.2019.0250. View

12.

Ikeda M, Yamashita T, Ogasawara S, Kudo M, Inaba Y, Morimoto M . Multicenter Phase II Trial of Lenvatinib plus Hepatic Intra-Arterial Infusion Chemotherapy with Cisplatin for Advanced Hepatocellular Carcinoma: LEOPARD. Liver Cancer. 2024; 13(2):193-202. PMC: 11095614. DOI: 10.1159/000531820. View

13.

Yamasaki T, Saeki I, Yamauchi Y, Matsumoto T, Suehiro Y, Kawaoka T . Management of Systemic Therapies and Hepatic Arterial Infusion Chemotherapy in Patients with Advanced Hepatocellular Carcinoma Based on Sarcopenia Assessment. Liver Cancer. 2022; 11(4):329-340. PMC: 9294968. DOI: 10.1159/000522389. View

14.

Kang Y, Guan Y, Li S . Innovative hydrogel solutions for articular cartilage regeneration: a comprehensive review. Int J Surg. 2024; 110(12):7984-8001. PMC: 11634198. DOI: 10.1097/JS9.0000000000002076. View

14.

Guan J, Li Z, Sheng S, Lin Q, Wang S, Wang D . An artificial intelligence-driven revolution in orthopedic surgery and sports medicine. Int J Surg. 2024; 111(2):2162-2181. DOI: 10.1097/JS9.0000000000002187. View

15.

Chang X, Wu H, Ning S, Li X, Xie Y, Shao W . Hepatic Arterial Infusion Chemotherapy Combined with Lenvatinib Plus Humanized Programmed Death Receptor-1 in Patients with High-Risk Advanced Hepatocellular Carcinoma: A Real-World Study. J Hepatocell Carcinoma. 2023; 10:1497-1509. PMC: 10493101. DOI: 10.2147/JHC.S418387. View

16.

Lencioni R, Llovet J . Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. Semin Liver Dis. 2010; 30(1):52-60. DOI: 10.1055/s-0030-1247132. View

17.

Reig M, Forner A, Rimola J, Ferrer-Fabrega J, Burrel M, Garcia-Criado A . BCLC strategy for prognosis prediction and treatment recommendation: The 2022 update. J Hepatol. 2021; 76(3):681-693. PMC: 8866082. DOI: 10.1016/j.jhep.2021.11.018. View

18.

Kudo M, Kawamura Y, Hasegawa K, Tateishi R, Kariyama K, Shiina S . Management of Hepatocellular Carcinoma in Japan: JSH Consensus Statements and Recommendations 2021 Update. Liver Cancer. 2021; 10(3):181-223. PMC: 8237791. DOI: 10.1159/000514174. View

19.

Cabibbo G, Daniele B, Borzio M, Casadei-Gardini A, Cillo U, Colli A . Multidisciplinary treatment of hepatocellular carcinoma in 2023: Italian practice Treatment Guidelines of the Italian Association for the Study of the Liver (AISF), Italian Association of Medical Oncology (AIOM), Italian Association of.... Dig Liver Dis. 2023; 56(3):394-405. DOI: 10.1016/j.dld.2023.10.028. View