Efficacy and safety of apatinib combined with transarterial chemoembolization for hepatocellular carcinoma with portal venous tumor thrombus: a retrospective study.

Changfu Liu,Wenge Xing,Haipeng Yu,Zhi Guo,Tongguo Si

doi:10.18632/oncotarget.20140

Abstract

ObjectiveTo investigate the efficacy and safety of combined therapy with apatinib and transarterial chemoembolization (TACE) for hepatocellular carcinoma with portal venous tumor thrombus (PVTT).Materials and MethodsWe retrospectively analyzed 19 patients with hepatocellular carcinoma with PVTT who were treated with apatinib and TACE at a single center between January 2015 and January 2017. Clinical information on the patients was collected. Adverse events, overall survival, progression-free survival, objective response rate, and disease-control rate based on mRECIST criteria (American Association for the Study of Liver Diseases, 2008) were reviewed and evaluated.ResultsAll patients had complete follow-up records and the median follow-up time was 13 months (1–24 months). Among the 19 patients, 63.16% achieved a partial response and 21.05% achieved stable disease. The objective response and disease-control rates for the tumor were 63.16% and 84.21%, respectively, and the objective response and disease-control rates for PVTT were 10.93% and 89.47%, respectively. The median overall survival was 11.9 months, and the 6-month and 1-year overall survival rates were 94.7% and 48.8%, respectively. The median progression-free survival rate was 8.1 months, and the 6-month and 1-year rates were 73.3% and 22.9%, respectively. The most common apatinib-related adverse events were hand-foot-skin reaction, fatigue, dyspepsia, diarrhea, and hypertension, and the most common TACE-related adverse event was fever. No procedure-related mortality or grade 4 adverse events were observed, but grade 3 adverse events were observed in two patients.ConclusionsThis exploratory study suggested that apatinib combined with TACE treatment was safe and might improve overall and progression-free survival in patients with hepatocellular carcinoma with PVTT. Further randomized controlled trials are needed to clarify the potential role of apatinib in hepatocellular carcinoma with PVTT.

Highlights

Hepatocellular carcinoma is the fifth most common malignancy and the third leading cause of cancer-related deaths worldwide [1, 2]
No procedure-related mortality or grade 4 adverse events were observed, but grade 3 adverse events were observed in two patients. This exploratory study suggested that apatinib combined with transarterial chemoembolization (TACE) treatment was safe and might improve overall and progression-free survival in patients with hepatocellular carcinoma with portal venous tumor thrombus (PVTT)
Further randomized controlled trials are needed to clarify the potential role of apatinib in hepatocellular carcinoma with PVTT

Summary

Introduction

Hepatocellular carcinoma is the fifth most common malignancy and the third leading cause of cancer-related deaths worldwide [1, 2]. Portal venous tumor thrombus (PVTT) is observed in 12.5%–62.2% of patients with advanced www.impactjournals.com/oncotarget hepatocellular carcinoma at their initial visit [3, 4]. PVTT may cause extensive intrahepatic dissemination of the tumor through the portal tract, decrease blood supply to the normal liver, and cause portal hypertension resulting in the rupture of collateral vessels, ascites, hepatic encephalopathy, and deteriorating liver function [5, 6]. These problems will affect the choice of treatments for patients with hepatocellular carcinoma

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Conclusion