PMID- 36970591 OWN - NLM STAT- MEDLINE DCOM- 20230331 LR - 20230331 IS - 2219-2840 (Electronic) IS - 1007-9327 (Print) IS - 1007-9327 (Linking) VI - 29 IP - 10 DP - 2023 Mar 14 TI - Clinical outcomes of lenvatinib plus transarterial chemoembolization with or without programmed death receptor-1 inhibitors in unresectable hepatocellular carcinoma. PG - 1614-1626 LID - 10.3748/wjg.v29.i10.1614 [doi] AB - BACKGROUND: Programmed death receptor-1 (PD-1) inhibitors have been approved as second-line treatment regimen in hepatocellular carcinoma (HCC), but it is still worth studying whether patients can benefit from PD-1 inhibitors as first-line drugs combined with targeted drugs and locoregional therapy. AIM: To estimate the clinical outcome of transarterial chemoembolization (TACE) and lenvatinib plus PD-1 inhibitors for patients with unresectable HCC (uHCC). METHODS: We carried out retrospective research of 65 patients with uHCC who were treated at Peking Union Medical College Hospital from September 2017 to February 2022. 45 patients received the PD-1 inhibitors, lenvatinib, TACE (PD-1-Lenv-T) therapy, and 20 received the lenvatinib, TACE (Lenv-T) therapy. In terms of the dose of lenvatinib, 8 mg was given orally for patients weighing less than 60 kg and 12 mg for those weighing more than 60 kg. Of the patients in the PD-1 inhibitor combination group, 15 received Toripalimab, 14 received Toripalimab, 14 received Camrelizumab, 4 received Pembrolizumab, 9 received Sintilimab, and 2 received Nivolumab, 1 with Tislelizumab. According to the investigators' assessment, TACE was performed every 4-6 wk when the patient had good hepatic function (Child-Pugh class A or B) until disease progression occurred. We evaluated the efficacy by the modified Response Evaluation Criteria in Solid Tumors (mRECIST criteria). We accessd the safety by the National Cancer Institute Common Terminology Criteria for Adverse Events, v 5.0. The key adverse events (AEs) after the initiation of combination therapy were observed. RESULTS: Patients with uHCC who received PD-1-Lenv-T therapy (n = 45) had a clearly longer overall survival than those who underwent Lenv-T therapy (n = 20, 26.8 vs 14.0 mo; P = 0.027). The median progression-free survival time between the two treatment regimens was also measured 11.7 mo [95% confidence interval (CI): 7.7-15.7] in the PD-1-Lenv-T group vs 8.5 mo (95%CI: 3.0-13.9) in the Lenv-T group (P = 0.028). The objective response rates of the PD-1-Lenv-T group and Lenv-T group were 44.4% and 20% (P = 0.059) according to the mRECIST criteria, meanwhile the disease control rates were 93.3% and 64.0% (P = 0.003), respectively. The type and frequency of AEs showed little distinction between patients received the two treatment regimens. CONCLUSION: Our results suggest that the early combination of PD-1 inhibitors has manageable toxicity and hopeful efficacy in patients with uHCC. CI - (c)The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved. FAU - Wang, Yan-Yu AU - Wang YY AD - Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China. FAU - Yang, Xu AU - Yang X AD - Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China. FAU - Wang, Yun-Chao AU - Wang YC AD - Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China. FAU - Long, Jun-Yu AU - Long JY AD - Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China. FAU - Sun, Hui-Shan AU - Sun HS AD - Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China. FAU - Li, Yi-Ran AU - Li YR AD - Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China. FAU - Xun, Zi-Yu AU - Xun ZY AD - Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China. FAU - Zhang, Nan AU - Zhang N AD - Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China. FAU - Xue, Jing-Nan AU - Xue JN AD - Department of General Surgery, Digestive Disease Hospital, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, Guizhou Province, China. FAU - Ning, Cong AU - Ning C AD - Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China. FAU - Zhang, Jun-Wei AU - Zhang JW AD - Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China. FAU - Zhu, Cheng-Pei AU - Zhu CP AD - Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China. FAU - Zhang, Long-Hao AU - Zhang LH AD - Department of General Surgery, Digestive Disease Hospital, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, Guizhou Province, China. FAU - Yang, Xiao-Bo AU - Yang XB AD - Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China. FAU - Zhao, Hai-Tao AU - Zhao HT AD - Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China. zhaoht@pumch.cn. LA - eng PT - Journal Article PL - United States TA - World J Gastroenterol JT - World journal of gastroenterology JID - 100883448 RN - 0 (Immune Checkpoint Inhibitors) RN - EE083865G2 (lenvatinib) RN - 0 (Programmed Cell Death 1 Receptor) RN - 0 (Receptors, Death Domain) SB - IM MH - Humans MH - *Carcinoma, Hepatocellular/drug therapy MH - *Chemoembolization, Therapeutic MH - *Immune Checkpoint Inhibitors/adverse effects/therapeutic use MH - *Liver Neoplasms/drug therapy MH - Programmed Cell Death 1 Receptor/antagonists & inhibitors MH - Receptors, Death Domain MH - Retrospective Studies PMC - PMC10037246 OTO - NOTNLM OT - Combination therapy OT - Hepatocellular carcinoma OT - Immunotherapy OT - Lenvatinib OT - Programmed death receptor-1 inhibitor OT - Transarterial chemoembolization COIS- Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article. EDAT- 2023/03/28 06:00 MHDA- 2023/03/28 19:05 PMCR- 2023/03/14 CRDT- 2023/03/27 03:54 PHST- 2022/11/30 00:00 [received] PHST- 2022/12/24 00:00 [revised] PHST- 2023/02/27 00:00 [accepted] PHST- 2023/03/28 19:05 [medline] PHST- 2023/03/27 03:54 [entrez] PHST- 2023/03/28 06:00 [pubmed] PHST- 2023/03/14 00:00 [pmc-release] AID - 10.3748/wjg.v29.i10.1614 [doi] PST - ppublish SO - World J Gastroenterol. 2023 Mar 14;29(10):1614-1626. doi: 10.3748/wjg.v29.i10.1614.