PMID- 33708910 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20220421 IS - 2305-5839 (Print) IS - 2305-5847 (Electronic) IS - 2305-5839 (Linking) VI - 9 IP - 4 DP - 2021 Feb TI - Transarterial chemoembolization (TACE) combined with apatinib versus TACE combined with sorafenib in advanced hepatocellular carcinoma patients: a multicenter retrospective study. PG - 283 LID - 10.21037/atm-20-5360 [doi] LID - 283 AB - BACKGROUND: The combination of transarterial chemoembolization (TACE) with sorafenib has demonstrated superior efficacy over sorafenib and TACE monotherapy in hepatocellular carcinoma (HCC). Apatinib, a new targeted agent, has been recently reported to prolong the survival of HCC patients, either alone or in combination with TACE. However, the superior regimen between TACE-apatinib and TACE-sorafenib in HCC patients has not been determined. In this study, we compared the efficacy and safety of TACE-apatinib versus TACE-sorafenib in advanced stage HCC patients. METHODS: The data of 201 HCC patients who had received TACE-sorafenib or TACE-apatinib between January 2016 and June 2018 in three hospitals were retrospectively reviewed. Overall survival (OS), progression-free survival (PFS), and adverse effects (AEs) between the two treatment groups were compared. A subgroup analysis based on the doses of targeted agents was also performed. RESULTS: No significant differences in baseline clinicopathological features were found between the two groups except for dose reduction. The TACE-apatinib group had higher incidences of hypertension, oral or anal ulcer and proteinuria, while the TACE-sorafenib group had higher incidences of diarrhea and alopecia. Grade 3/4 AEs occurred more frequently in the TACE-apatinib group than in the TACE-sorafenib group (52.3% vs. 22.6%, P<0.001). The TACE-sorafenib group had better PFS than the TACE-apatinib group (median PFS: 5.0 vs. 6.0 months, P=0.002) while the two groups showed no difference in OS (median OS: 13.0 vs. 13.0 months, P=0.448). The TACE-apatinib group had a higher rate of targeted agent dose reduction than the TACE-sorafenib group (53.5% vs. 17.4%, P<0.001). When the patients were stratified into normal and reduced-dose subgroups, those who received TACE-sorafenib exhibited improved PFS but similar OS compared with the patients who received TACE-apatinib in the reduced-dose subgroup (median OS: 12.0 vs. 13.3 months, P=0.614; median PFS: 3.0 vs. 7.0 months, P<0.001). Multivariable analysis validated that treatments and dose reduction were independent prognostic factors for PFS among all patients. CONCLUSIONS: Compared with TACE-sorafenib, the strategy of TACE-apatinib yielded shorter PFS in advanced HCC patients while no difference in OS was observed. A high rate of AE-related dose reduction of apatinib could account for the observed differences. CI - 2021 Annals of Translational Medicine. All rights reserved. FAU - Qiu, Zhiyu AU - Qiu Z AD - State Key Laboratory of Oncology in South China and Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University, Guangzhou, China. AD - Department of Liver Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China. FAU - Shen, Lujun AU - Shen L AD - State Key Laboratory of Oncology in South China and Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University, Guangzhou, China. AD - Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China. FAU - Jiang, Yiquan AU - Jiang Y AD - State Key Laboratory of Oncology in South China and Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University, Guangzhou, China. AD - Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China. AD - Department of Hepatic Surgery and Liver Transplantation Center, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. FAU - Qiu, Jiliang AU - Qiu J AD - State Key Laboratory of Oncology in South China and Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University, Guangzhou, China. AD - Department of Liver Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China. FAU - Xu, Zining AU - Xu Z AD - Department of Minimally Invasive Interventional Radiology, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China. FAU - Shi, Mengting AU - Shi M AD - Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China. FAU - Yu, Zhentao AU - Yu Z AD - Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China. FAU - Ma, Yanping AU - Ma Y AD - Department of Radiology, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. FAU - He, Wei AU - He W AD - State Key Laboratory of Oncology in South China and Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University, Guangzhou, China. AD - Department of Liver Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China. FAU - Zheng, Yun AU - Zheng Y AD - State Key Laboratory of Oncology in South China and Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University, Guangzhou, China. AD - Department of Liver Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China. FAU - Li, Binkui AU - Li B AD - State Key Laboratory of Oncology in South China and Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University, Guangzhou, China. AD - Department of Liver Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China. FAU - Wang, Guoying AU - Wang G AD - Department of Hepatic Surgery and Liver Transplantation Center, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. FAU - Yuan, Yunfei AU - Yuan Y AD - State Key Laboratory of Oncology in South China and Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University, Guangzhou, China. AD - Department of Liver Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China. LA - eng PT - Journal Article PL - China TA - Ann Transl Med JT - Annals of translational medicine JID - 101617978 PMC - PMC7944263 OTO - NOTNLM OT - Hepatocellular carcinoma (HCC) OT - apatinib OT - prognosis OT - sorafenib OT - transarterial chemoembolization (TACE) COIS- Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/atm-20-5360). The authors have no conflicts of interest to declare. EDAT- 2021/03/13 06:00 MHDA- 2021/03/13 06:01 PMCR- 2021/02/01 CRDT- 2021/03/12 07:20 PHST- 2021/03/12 07:20 [entrez] PHST- 2021/03/13 06:00 [pubmed] PHST- 2021/03/13 06:01 [medline] PHST- 2021/02/01 00:00 [pmc-release] AID - atm-09-04-283 [pii] AID - 10.21037/atm-20-5360 [doi] PST - ppublish SO - Ann Transl Med. 2021 Feb;9(4):283. doi: 10.21037/atm-20-5360.