Transarterial Chemoembolization (TACE) Combined with Lenvatinib versus TACE Alone in Intermediate-Stage Hepatocellular Carcinoma Patients Beyond Up-To-Seven Criteria: A Retrospective, Propensity Score-Matched Analysis

Churen Zhou; Boyang Chang; Zhanwang Xiang; Zhengran Li; Chun Wu; Mingjun Bai; Zaibo Jiang; Mingsheng Huang; Junwei Chen

doi:10.1016/j.acra.2024.04.045

Transarterial Chemoembolization (TACE) Combined with Lenvatinib versus TACE Alone in Intermediate-Stage Hepatocellular Carcinoma Patients Beyond Up-To-Seven Criteria: A Retrospective, Propensity Score-Matched Analysis

Acad Radiol. 2024 May 16:S1076-6332(24)00280-0. doi: 10.1016/j.acra.2024.04.045. Online ahead of print.

Authors

Churen Zhou¹, Boyang Chang¹, Zhanwang Xiang¹, Zhengran Li¹, Chun Wu¹, Mingjun Bai¹, Zaibo Jiang¹, Mingsheng Huang¹, Junwei Chen²

Affiliations

¹ Department of Interventional Radiology, the Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, China.
² Department of Interventional Radiology, the Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, China. Electronic address: chenjw53@mail.sysu.edu.cn.

PMID: 38760273
DOI: 10.1016/j.acra.2024.04.045

Abstract

Rationale and objectives: To compare the treatment efficacy and safety of transarterial chemoembolization (TACE) combined with lenvatinib versus TACE alone in patients with intermediate-stage hepatocellular carcinoma (HCC) beyond up-to-seven criteria.

Materials and methods: A total of 107 newly diagnosed HCC patients with Barcelona Clinic Liver Cancer stage B HCC beyond up-to-seven criteria were included in this retrospective cohort study. These patients were divided into two groups: TACE-Lenv group and TACE alone group. Propensity score matching was used to account for potential confounding factors. Overall survival (OS), progression-free survival (PFS), objective response rate (ORR), disease control rate (DCR), downstaging rate, liver function, and adverse events (AEs) were recorded and evaluated.

Results: Both the median OS and median PFS were significantly longer in the TACE-Lenv group compared to the TACE alone group (median OS: 28.0 vs 12.0 months, P = 0.017; median PFS [mRECIST]: 8.2 vs 3.7 months, P = 0.018; median PFS [RECIST v1.1]: 8.9 vs 3.7 months, P = 0.003). Furthermore, the ORR and DCR were also significantly higher in TACE-Lenv group (ORR: 94% [30/32] vs 47% [15/32], P < 0.001; DCR: 97% [31/32] vs 62% [20/32], P < 0.001). There were no significant differences in terms of liver function and grade 3 or 4 AEs rate between two groups.

Conclusion: The combination of TACE and lenvatinib provides clinical benefits for patients with intermediate HCC beyond the up-to-seven criteria, has an acceptable safety profile, shows a trend towards improving liver function, and does not increase the occurrence of grade 3-4 AEs.

Key points: The efficacy of transarterial chemoembolization in intermediate-stage hepatocellular carcinoma patients is partially unsatisfactory. Addition of lenvatinib to transarterial chemoembolization improves OS, PFS, ORR, and DCR for patients with intermediate-stage hepatocellular carcinoma beyond the up-to-seven criteria. This combination therapy is a superior treatment option for intermediate-stage hepatocellular carcinoma patients with high tumor burden.

Keywords: Hepatocellular carcinoma (HCC); Intermediate stage (BCLC-B); Transarterial chemoembolization (TACE); Tyrosine kinase inhibitor (TKI); Up-to-seven criteria.