AI Article Synopsis

  • This study evaluates the effectiveness and safety of a combined therapy (TACE + lenvatinib + PD-1 inhibitor + iodine-125 brachytherapy) for HCC patients with portal vein tumor thrombosis compared to other approaches.
  • The research analyzed data from 150 patients to measure outcomes like overall survival (OS) and progression-free survival (PFS), finding that the combined therapy significantly improved these metrics.
  • The results showed that the combined treatment group had a noticeably longer OS and PFS compared to other treatment groups, with no significant differences in adverse events reported.

Article Abstract

Background: Therapy for hepatocellular carcinoma (HCC) patients with portal vein tumor thrombosis (PVTT) is still controversial. This study was performed to evaluate the efficacy and safety of the combination therapy comprising transarterial chemoembolization (TACE), lenvatinib (L), programmed death-1 inhibitor (P), and iodine-125 seed (I) brachytherapy relative to TACE in combination with lenvatinib plus programmed death-1 inhibitor therapy and TACE plus lenvatinib therapy.

Methods: The data of HCC patients with PVTT from July 2017 to August 2022 were assessed in this single-center retrospective study. Primary study outcomes were progression-free survival (PFS) and overall survival (OS), while the secondary outcomes were disease control rate (DCR), objective response rate (ORR), and treatment-related adverse events.

Results: We enrolled 150 patients totally, including 50 patients treated with TACE plus lenvatinib therapy (TACE+L group), 45 patients treated with TACE in combination with lenvatinib plus programmed death-1 inhibitor therapy (TACE+L+P group), and 55 patients treated with the combination therapy of TACE along with I brachytherapy, lenvatinib, and programmed death-1 inhibitor therapy (TACE+L+P+I group). The median OS in the TACE+L+P+I group (21.0; 95% confidence interval [CI]: 18.4∼23.5 months) was significantly longer than that in the TACE+L group (10; 95% CI: 7.8∼12.1months) (p = 0.006), while it was insignificantly longer than that in the TACE+L+P group (14.0; 95% CI: 10.7∼17.2months) (p = 0.058). The median PFS in the TACE+L+P+I group (13.0; 95% CI: 10.2∼15.7 months) was significantly longer than that in the TACE+L group (5.0; 95% CI: 4.2∼5.7 months) (p = 0.014) and the TACE+L+P group (9.0; 95% CI: 6.7∼11.2 months) (p = 0.048). Statistically significant differences between groups were found in DCR (p = 0.015). There were no significant between-group differences in treatment-related adverse events (p > 0.05).

Conclusions: A combination therapy of TACE, lenvatinib, programmed death-1 inhibitor, and I seed brachytherapy significantly improve OS, PFS, and DCR and show better survival prognosis for HCC patients accompanied by PVTT.

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Source
http://dx.doi.org/10.1016/j.brachy.2023.06.229DOI Listing

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