Hepatic artery infusion chemotherapy using mFOLFOX versus transarterial chemoembolization for massive unresectable hepatocellular carcinoma: a prospective non-randomized study

The comparative efficacy and safety between lenvatinib and hepatic artery infusion chemotherapy (HAIC) in patients with unresectable hepatocellular carcinoma (HCC) are still unclear. This multicenter historical cohort study enrolled 244 patients who were treated with HAIC (n = 173) or lenvatinib (n = 71) between 2012 and 2020. Propensity score matching (PSM) was performed, and 52 patients were selected per group. Clinical outcomes and safety were compared. Objective response rate (ORR) was not different between the two groups (26.0% vs. 23.1%, P = 0.736). Before PSM, HAIC group had a higher proportion of Child-Pugh B and portal vein tumor, whereas lenvatinib group had more patients with extrahepatic metastases, which was adjusted after PSM. There were no differences in progression-free survival (PFS) and overall survival (OS) after PSM (HAIC vs. lenvatinib, median PFS, 3.6 vs. 4.0 months, P = 0.706; median OS 10.8 vs. 7.9 months, P = 0.106). Multivariate Cox-regression showed that alpha-fetoprotein ≤ 1000 ng/mL was only associated factor for OS after PSM in all patients (hazard ratio = 0.421, P = 0.011). Subgroup analysis for patients with high tumor burden beyond the REFLECT eligibility criteria revealed that HAIC group (n = 29) had a significantly longer OS than did lenvatinib group (n = 30) (10.0 vs. 5.4 months, P=0.004). More patients in HAIC group achieved better liver function than those in lenvatinib group at the time of best responses. There was no difference in the incidence of grade 3 and 4 adverse events between the two groups. Therefore, lenvatinib is comparable to HAIC in terms of ORR and OS in unresectable HCC meeting REFLECT eligibility criteria.

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Letter to the Editor Regarding “Hepatic artery infusion chemotherapy using mFOLFOX versus transarterial chemoembolization as initial treatment for locally advanced hepatocellular carcinoma: a propensity score-matching analysis”

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2021.10.040 ◽

2021 ◽

Author(s):

Jiachen Xu ◽

Caifang Ni

Keyword(s):

Hepatocellular Carcinoma ◽

Propensity Score ◽

Transarterial Chemoembolization ◽

Initial Treatment ◽

Locally Advanced ◽

Hepatic Artery Infusion ◽

Advanced Hepatocellular Carcinoma ◽

Infusion Chemotherapy ◽

Propensity Score Matching Analysis ◽

Hepatic Artery Infusion Chemotherapy

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Effects of Antiviral Therapy on HBV Reactivation and Survival in Hepatocellular Carcinoma Patients Undergoing Hepatic Artery Infusion Chemotherapy

Frontiers in Oncology ◽

10.3389/fonc.2020.582504 ◽

2021 ◽

Vol 10 ◽

Author(s):

Shousheng Liu ◽

Jinfa Lai ◽

Ning Lyu ◽

Qiankun Xie ◽

Huijiao Cao ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Hepatitis B ◽

Hepatic Artery ◽

Primary Hepatocellular Carcinoma ◽

Hepatic Artery Infusion ◽

Hbv Reactivation ◽

Antiviral Prophylaxis ◽

Advanced Hcc ◽

Infusion Chemotherapy ◽

Hepatic Artery Infusion Chemotherapy

BackgroundThis study aimed to investigate the influence of hepatic artery infusion chemotherapy (HAIC) on hepatitis B virus (HBV) reactivation in hepatitis B surface antigen (HBsAg) positive patients with primary hepatocellular carcinoma (HCC) as well as evaluate the role of antiviral prophylaxis in these patients.MethodsWe enrolled 170 HBsAg-positive advanced HCC patients receiving HAIC using mFOLFOX regimen, of which 137 patients received antiviral prophylaxis. Risk factors for HBV reactivation were analyzed. The overall survival (OS) from the first application of HAIC were compared between antiviral and non-antiviral groups.ResultsA total of 25 patients (14.7%) developed HBV reactivation after HAIC, of which 16 patients received antiviral treatment and nine patients did not. The incidence of HBV reactivation was 11.7% (16/137) in antiviral group and 27.3% (9/33) in non-antiviral group respectively. No antiviral prophylactic was the only significant risk factor for HBV reactivation (OR=12.35, 95% confidence interval (CI) 4.35–33.33, p<0.001). Patients in antiviral group received more cycles of HAIC compared with non-antiviral group (3.11 ± 1.69 vs 1.75 ± 1.18, p<0.05) at the time of HBV reactivated. Seven of the 25 HBV reactivation patients developed hepatitis. OS in antiviral group was significantly longer than that of non-antiviral group (median 16.46 vs 10.68 months; HR=0.57; 95% CI, 0.36–0.91; p<0.05).ConclusionsHBV reactivation is more prone to occur in the HBsAg-positive HCC patients undergoing HAIC without antiviral prophylaxis. Regular monitoring of HBV DNA and antiviral prophylaxis are suggested to prevent HBV reactivation as well as prolong the OS of these patients.Name of the Trial RegisterHAIC Using Oxaliplatin Plus Fluorouracil/Leucovorin for Patients with Locally Advanced HCC.Clinical Trial Registrationhttps://www.clinicaltrials.gov/, identifier NCT 02436044

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946P Hepatic artery infusion chemotherapy (HAIC) combined with apatinib and camrelizumab for hepatocellular carcinoma (HCC) in BCLC stage C: A prospective, single-arm, phase II trial (TRIPLET study)

Annals of Oncology ◽

10.1016/j.annonc.2021.08.166 ◽

2021 ◽

Vol 32 ◽

pp. S825

Author(s):

T-Q. Zhang ◽

M-X. Zuo ◽

Z-J. Geng ◽

Z-L. Huang ◽

J-B. Li ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Hepatic Artery ◽

Phase Ii ◽

Phase Ii Trial ◽

Hepatic Artery Infusion ◽

Infusion Chemotherapy ◽

Hepatic Artery Infusion Chemotherapy

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Meta-Analysis of Postoperative Adjuvant Hepatic Artery Infusion Chemotherapy Versus Surgical Resection Alone for Hepatocellular Carcinoma

Frontiers in Oncology ◽

10.3389/fonc.2021.720079 ◽

2021 ◽

Vol 11 ◽

Author(s):

Qiao Ke ◽

Lei Wang ◽

Weimin Wu ◽

Xinhui Huang ◽

Ling Li ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Hepatic Artery ◽

Surgical Resection ◽

Meta Analysis ◽

Disease Free Survival ◽

Cochrane Library ◽

Hepatic Artery Infusion ◽

Infusion Chemotherapy ◽

Hepatic Artery Infusion Chemotherapy

BackgroundTo systematically identify the long-term efficacy of postoperative adjuvant hepatic artery infusion chemotherapy (HAIC) for patients with hepatocellular carcinoma (HCC).MethodsPubMed, MedLine, Embase, the Cochrane Library, and Web of Science were searched to collect the eligible studies up to March 31, 2021, that compared the surgical resection (SR) versus SR+HAIC for HCC patients. The endpoints were overall survival (OS) rates and disease-free survival (DFS) rates, and the effect size was determined by hazard ratio (HR) with 95% CI.ResultsA total of 12 studies (two randomized controlled trials (RCTs) and 10 non-RCTs) including 1,333 patients were eligible for this meta-analysis. The pooled results showed that OS and DFS rates in the SR+HAIC group were both better than those in the SR alone group (HR = 0.56, 95% CI = 0.41–0.77, p < 0.001; HR = 0.66, 95% CI = 0.55–0.78, p < 0.001, respectively). Furthermore, the subgroup analysis showed that patients would benefit from SR+HAIC regardless of chemotherapy regimens and courses (all p < 0.05), and patients with microvascular or macrovascular invasion would also benefit more from SR+HAIC in terms of OS and DFS (all p < 0.05).ConclusionPostoperative adjuvant HAIC could improve the long-term prognosis of HCC patients, especially for those with microvascular or macrovascular invasion, regardless of chemotherapy regimens and courses, but it deserves further validation.

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