Minimally invasive procedure combined with Lenvima and checkpoint blockade shows promise in unresectable liver cancer


Transarterial chemoembolization (TACE), a procedure in which treatment is delivered directly to the liver, is safe and effective when combined with Lenvima (lenvatinib) and PD-1 checkpoint blockade – a type of immunotherapy – for the treatment of patients with advanced disease. unresectable hepatocellular carcinoma (HCC), according to study results.

“More than 70% of patients with hepatocellular carcinoma are at an intermediate or advanced stage at the time of diagnosis,” explained the authors in their abstract, which was presented at the 2022 ASCO Symposium on Gastrointestinal Cancers. “There are few scientific trials to confirm the safety and efficacy of TACE plus (a tyrosine kinase inhibitor) plus PD-1 antibody for the treatment of HCC (unresectable).”

A prospective study is analyzing outcomes for patients with unresectable HCC who received TACE, Lenvima and camrelizumab and sintilimab. A control group of patients received TACE alone. While the study is still ongoing, the researchers presented the current results of the study.

Study participants (92% male) were required to be between the ages of 18 and 70, have HCC confirmed by histopathology or cytology, have no history of systemic treatment, and have an ECOG PS score – which measures the level at which cancer and its treatments affect a person’s daily life — from 0 or 1, meaning they had minimal limitations due to their disease.

At a mean follow-up of 33.34 weeks, the conversion resection rate was 50% (19 patients) and the conversion success rate was 52.6% (20 patients). Of the 19 patients who converted to resection, five achieved a pathological complete response, meaning there was no evidence of cancer in the tissue removed during surgery. Additionally, one patient had a major pathological response, defined as 10% or fewer viable tumors remaining in the resected tissue.

Additionally, at 48 weeks, 96.4% of the patient population were still alive and 91.7% were still alive without their disease getting worse – a statistic known as progression-free survival.

There were no life-threatening side effects or treatment-related deaths, although 22 patients experienced stage 3 treatment-related side effects. Of these patients, three had their doses reduced and none discontinued treatment due to side effects.

The most common side effects, regardless of severity, were: abdominal pain (71%; 27 patients); increased aspartate aminotransferase, which may be a sign of liver damage (65.8%; 25 patients); and arterial hypertension (57.9%; 22 patients).

This research was not the first time that TACE and immunotherapy have been combined to treat liver cancer. In fact, TACE has already been studied in combination with Opdivo (nivolumab), a PD-L1 inhibitor. In this trial, more than 70% of patients responded to treatment.

Ultimately, the authors concluded that “TACE (plus Lenvima) and PD-1 antibody (treatment) are safe and effective, and conversion resection after triple treatment is feasible for HCC (unresectable) .”

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