Long-term outcomes of radiotherapy combined with immune checkpoint blockade inhibitor and lenvatinib therapy in hepatocellular carcinoma with portal vein tumor thrombus

Abstract

Abstract: Objective:To explore the efficacy and safety of radiotherapy combined with immune checkpoint blockade inhibitor(PD-1 inhibitor) and lenvatinib in hepatocellular carcinoma (HCC) patients with portal vein tumor thrombus (PVTT).
Methods:Between March 2018 to October 2020, patients diagnosed with unresectable HCC with PVTT who were admitted to our hospital were screened. In whom we included patients who met Barcelona Clinic Liver Cancer (BCLC) stage C, with Vp3 or Vp4 type portal vein tumor thrombus, and had no prior systemic treatment. The primary endpoints were 3-year overall survival (OS), progression-free survival (PFS), and objective response rate (ORR) of PVTT. Kaplan-Meier analysis was used for survival analysis and log-rank test was performed.
Results:47 patients were enrolled in the study, 39 of whom had Vp4 type PVTT. The median follow-up duration was 33.9 (range: 3.1-57.1) months. The median OS tuime was 11.9 (95%CI:7.5-16.3) months, and the 3-year OS rate was 18%. The median PFS tiume was 5 months(95%CI:3.5-6.5 months) , and the 3-year PFS rate was 10%. Among patients with Vp4 type PVTT, the median OS time was 9.4 months (95%CI:8.3-10.5 months) , and the 3-year OS rate was 13%. The median PFS time was 4.9 months (95%CI:3.2-6.6 months), and the 3-year PFS rate was 9%. The objective response rate of PVTT was 75%. No grade 3 or higher adverse events occurred.
Conclusions:Radiotherapy combined with PD-1 inhibitor and lenvatinib in HCC patients with PVTT demonstrated favorable long-term efficacy and low toxicity. This triple combination therapy may become one of the competitive treatment options for HCC with BCLC stage C.

Key words: Hepatocellular carcinoma, Portal vein tumour thrombus, Radiotherapy, Programmed death receptor-1 inhibitor, Lenvatinib

Zhao Ying, Li Kewei, Yang Yanmei, Li Wei, Li Guangxin, Li Gong. Long-term outcomes of radiotherapy combined with immune checkpoint blockade inhibitor and lenvatinib therapy in hepatocellular carcinoma with portal vein tumor thrombus[J]. Electronic Journal of Liver Tumor, 2023, 10(3): 58-63.

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