Combination of Sorafenib, Camrelizumab, Transcatheter Arterial Chemoembolization, and Stereotactic Body Radiation Therapy as a Novel Downstaging Strategy in Advanced Hepatocellular Carcinoma With Portal Vein Tumor Thrombus: A Case Series Study.

Yun Huang,Zeyu Zhang,Kuan Hu,Weijun Liao,Zhiming Wang

doi:10.3389/fonc.2021.650394

Abstract

Background and AimAlthough the treatment effect and availability of therapeutic options for advanced hepatocellular carcinoma (HCC) are limited, the downstaging strategy may improve patient prognosis. This study aimed to investigate the potential of combination therapy as a downstaging strategy for treating advanced HCC with portal vein tumor thrombus (PVTT).MethodsThis retrospective case series included patients having advanced HCC with PVTT, who received the combination therapy of sorafenib, camrelizumab, transcatheter arterial chemoembolization (TACE), and stereotactic body radiation therapy (SBRT) from January 2019 to December 2019 in Xiangya Hospital, Central South University. The downstaging rate, treatment responses, progression-free survival (PFS), overall survival (OS), disease control rate, and toxicities were evaluated.ResultsOf the 13 patients, HCC downstaging was achieved in 4 (33.3%) patients who later received hepatectomy. The overall response rate was 41.7%, and the disease control rate was 50.0%. The median PFS time was 15.7 months, with a 1-year PFS rate of 58.3%, whereas the median OS was not reached after 1 year (1-year OS, 83.3%). No severe adverse events or grade 3–4 adverse effect was observed in 12 of the 13 enrolled patients; therapy had to be discontinued in only one patient due to adverse events, who was excluded from the study. The most common adverse effect was fever (n = 4, 33.3%), followed by skin reaction (n = 3, 25%).ConclusionA combination therapy comprising sorafenib, camrelizumab, TACE, and SBRT is an effective downstaging strategy for advanced HCC with PVTT and is associated with few adverse events.

Highlights

Hepatocellular carcinoma (HCC) is the most common liver malignancy and the fourth leading cause of death worldwide [1]
No severe adverse events or grade 3–4 adverse effect was observed in 12 of the 13 enrolled patients; therapy had to be discontinued in only one patient due to adverse events, who was excluded from the study
HCC was diagnosed using the noninvasive criteria of the European Association for the Abbreviations: BCLC, the Barcelona Clinic Liver Cancer; CT, computed tomography; HCC, hepatocellular carcinoma; ICI, immune checkpoint inhibitors; modified response evaluation criteria in solid tumors (mRECIST), the modified Response Evaluation Criteria in Solid Tumors; NCI-CTCAE, The National Cancer Institute–Common Terminology Criteria for Adverse Events; ORR, overall response rate; OS, overall survival; PFS, progression-free survival; Portal vein tumor thrombosis (PVTT), portal vein tumor thrombus; SBRT, stereotactic body radiation therapy; SD, standard deviation; TACE, transcatheter arterial chemoembolization; TKI, tyrosine kinase inhibitor

Summary

Introduction

Hepatocellular carcinoma (HCC) is the most common liver malignancy and the fourth leading cause of death worldwide [1]. Portal vein tumor thrombosis (PVTT) occurs in approximately 35%–50% of patients with HCC It is a negative prognostic factor due to the increased risk of hematogenous tumor spread, leading to a high recurrence risk [2]. Therapies such as transcatheter arterial chemoembolization (TACE), chemotherapy, radiotherapy, tyrosine kinase inhibitor (TKI), and immune checkpoint inhibitors (ICI) can be potentially used to treat advanced HCC. The treatment effect and availability of therapeutic options for advanced hepatocellular carcinoma (HCC) are limited, the downstaging strategy may improve patient prognosis. This study aimed to investigate the potential of combination therapy as a downstaging strategy for treating advanced HCC with portal vein tumor thrombus (PVTT)

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