Abstract
ObjectiveThis study was conducted in order to compare the efficacy and safety of transarterial chemoembolization (TACE) plus apatinib plus camrelizumab (TACE+AC) and apatinib plus camrelizumab (AC) in the treatment of unresectable hepatocellular carcinoma (HCC) in a real-world setting.MethodsIn this single-center retrospective study, the data of patients with unresectable HCC who had received TACE+AC or AC treatment during March 2017 to May 2021 were assessed. Patients in the AC group received intravenous administration of camrelizumab 200 mg every 3 weeks and oral apatinib 250 mg/day treatment. Patients in the TACE+AC group received the same dose of camrelizumab and apatinib 1 week after TACE. The primary endpoint of the study was overall survival (OS), objective response rate (ORR), disease control rate (DCR), and adverse events (AEs) as the secondary endpoints.ResultsA total of 108 patients were enrolled in the study. There were 52 patients in the AC group and 56 patients in TACE+AC group. Median OS was significantly longer in the TACE+AC group than in the AC group (24.8 vs. 13.1 months; P = 0.005). Patients in the TACE+AC group achieved a higher ORR [24 (42.9%) vs. 9 (17.3%), P = 0.004] than those in the AC group. Patients in the TACE+AC group also achieved a higher disease control rate (DCR) [48 (85.7%) vs. 30 (57.7%), P = 0.001] than patients in the AC group. There was no significant difference in the incidence of AEs related to apatinib and camrelizumab between the two groups, except for gastrointestinal reaction (P > 0.05, all; P < 0.05, gastrointestinal reaction).ConclusionTACE plus apatinib plus camrelizumab significantly improved OS, ORR, and DCR over apatinib plus camrelizumab in patients with unresectable HCC. AEs were tolerable and manageable.
Highlights
Liver cancer is the sixth most common cancer and the fourth leading cancer-related cause of death worldwide [1]
Patients in the transarterial chemoembolization (TACE)+apatinib plus camrelizumab (AC) group received the same dose of camrelizumab and apatinib 1 week after TACE
There was no significant difference in the incidence of adverse events (AEs) related to apatinib and camrelizumab between the two groups, except for gastrointestinal reaction (P > 0.05, all; P < 0.05, gastrointestinal reaction)
Summary
Liver cancer is the sixth most common cancer and the fourth leading cancer-related cause of death worldwide [1]. Hepatocellular carcinoma (HCC) is the main histological subtype of liver cancer and accounts for about 90% of cases [2]. Transcatheter therapy that included transarterial embolization (TAE) and transarterial chemoembolization (TACE) has been used for unresectable hepatic tumors [5, 6]. Compared with TAE, TACE can increase the intertumor concentration of the chemotherapeutic agent. Doxorubicin is the preferred and most common chemotherapeutic agent used in TACE and it is considered an immunogenic drug, potentiating immunogenic cell death [6, 7]. TACE is widely used in the treatment of intermediate and advanced HCC, especially unresectable hepatocellular carcinoma [8, 9]. Preclinical models have shown that the combination of anti-angiogenic therapy with TACE reduced tumor volume and vessel density and prolonged survival compared with TACE alone [11]
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