Abstract
BackgroundWe evaluated organ-specific response rates (OSRRs) to first-line lenvatinib plus anti-PD-1 antibodies in patients with advanced hepatocellular carcinoma (HCC).MethodsThis retrospective analysis included Chinese patients with unresectable/advanced HCC who received first-line lenvatinib (8 mg/day) plus ≥3 infusions of anti-PD-1 antibodies between October 2018 and May 2020. Tumor and macrovascular tumor thrombi (MVTT) treatment responses were evaluated every 2 months using RECIST v1.1. The overall response rate (ORR)/OSRR was defined as the percentage of patients with a best overall response of complete or partial response (CR or PR).ResultsIn total, 60 patients were included in the analysis; 96.7% had measurable intrahepatic lesions, 55% had MVTT and 26.7% had extrahepatic disease. In all 60 patients, the ORR was 33.3%, median progression-free survival was 7.0 months (95% CI, 1.7–12.3) and median overall survival was not reached. The OSRR for MVTT (54.5%) was higher versus intrahepatic tumors (32.8%), extrahepatic lung metastases (37.5%) and lymph node metastases (33.3%). Among 33 patients with intrahepatic tumors and MVTT, 18 had differential responses in each site, including 13 with a better response in MVTT versus intrahepatic lesions. Among 18 patients whose MVTT achieved a radiographic CR or PR, six underwent surgical resection: 4/6 achieved a pathological CR in MVTT and 2/6 in the intrahepatic tumor.ConclusionsFirst-line lenvatinib plus anti-PD-1 antibodies resulted in better tumor responses in MVTT versus intrahepatic lesions. Complete MVTT necrosis may allow downstaging and subsequent eligibility for surgical resection in a proportion of patients with advanced HCC.
Highlights
Hepatocellular carcinoma (HCC) is the most common cancer of the liver, and is the fourth-most-common cause of cancer-related death worldwide [1]
The results of this study demonstrate differential organspecific responses to combined lenvatinib plus anti-progressive disease (PD)-1 monoclonal antibodies in patients with advanced hepatocellular carcinoma (HCC)
There have been previous reports of organ-specific responses to immunotherapy in the second-line treatment of HCC [16, 17]. To our knowledge, this is the first report of organ-specific responses to first-line combination treatment with lenvatinib plus anti-programmed cell death-1 (PD-1) antibodies in patients with advanced HCC
Summary
Hepatocellular carcinoma (HCC) is the most common cancer of the liver, and is the fourth-most-common cause of cancer-related death worldwide [1]. Patients with early and intermediate stage HCC can access treatment options associated with the best long-term survival, including liver resection, orthotopic liver transplant and locoregional therapies [2]. For patients diagnosed with advanced HCC (accounting for > 50% of patients [3]) or those who progress following locoregional therapy, treatment options are usually limited to systemic therapy and the prognosis is often poor [4, 5]. Immunotherapy with anti-programmed cell death-1 (PD-1) antibodies (nivolumab and pembrolizumab) has been investigated in advanced HCC, with mixed results [9,10,11]. We evaluated organ-specific response rates (OSRRs) to first-line lenvatinib plus anti-PD-1 antibodies in patients with advanced hepatocellular carcinoma (HCC)
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