Efficacy of chemoembolization with drug-eluting bead combined with Donafenib and PD-1 in the treatment of advanced large liver cancer

doi:10.3877/cma.j.issn.2095-5782.2024.03.004

Abstract

Abstract:

Objective

To evaluate the clinical efficacy and safety of DEB-TACE combined with Donafenib and programmed cell death receptor-1 inhibitor (PD-1) in the treatment of advanced large liver cancer.

Methods

Clinical data of 15 patients with large liver cancer admitted to our hospital from March 2022 to March 2023 were retrospectively analyzed, and the overall survival (OS) and progression-free survival (PFS) were recorded. Objective response rate (ORR), disease control rate (DCR) and treatment-related adverse events (trAEs) were evaluated.

Results

All 15 patients were successfully treated with DEB-TACE combined with Donafinil and PD-1. The median number of DEB-TACE was 2, with an average of 2.0 ± 0.85. ORR and DCR were 73.33% and 93.33%, respectively, one month after TACE. The median follow-up time was 16 months, the median PFS was 11.0 (95%CI: 9.40-13.56) months, and the median OS was 20.1 (95%CI: 16.00-22.79) months. TRAE was mainly grade 1 to 2, which was alleviated after proper administration or reduction of dosage, and no AE above grade 3 occurred.

Conclusion

DEB-TACE combined with Donafinil and PD-1 has good efficacy, safety and tolerance in the treatment of middle and advanced large liver cancer, and can be used as the first-line treatment for potential middle and advanced large liver cancer.

Key words: Drug-eluting bead, Donafenib, Immunosuppressant, Large liver cancer, Systemic therapy

Heqing Ye, Jie Li, Yuyuan Zhang, Luqi Hu, Bailu Wu, Xin Li, Shuwen Ye, Yifan Li, Yue Gao, Pengchao Zhan, Peijie Lv, Zhen Li. Efficacy of chemoembolization with drug-eluting bead combined with Donafenib and PD-1 in the treatment of advanced large liver cancer[J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2024, 12(03): 212-216.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhjrfsxdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-5782.2024.03.004

https://zhjrfsxdzzz.cma-cmc.com.cn/EN/Y2024/V12/I03/212

Figures/Tables 4

References 25

[1]	Zhou M, Wang H, Zeng X, et al. Mortality, morbidity, and risk factors in China and its provinces, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017[J]. Lancet, 2019, 394(10204): 1145-1158.
[2]	国家卫生健康委办公厅. 原发性肝癌诊疗指南(2022年版)[J]. 临床肝胆病杂志, 2022, 38(2): 288-303.
[3]	Han T, Yang X, Zhang Y, et al. The clinical safety and efficacy of conventional transcatheter arterial chemoembolization and drug-eluting beads-transcatheter arterial chemoembolization for unresectable hepatocellular carcinoma: a meta-analysis[J]. Biosci Trends, 2019, 13(5): 374-381.
[4]	Huang M, Wang L, Chen J, et al. Regulation of COX-2 expression and epithelial-to-mesenchymal transition by hypoxia-inducible factor-1α is associated with poor prognosis in hepatocellular carcinoma patients post TACE surgery[J]. Int J Oncol, 2016, 48(5): 2144-2154.
[5]	Finn RS, Qin S, Ikeda M, et al. Atezolizumab plus bevacizumab in unresectable hepatocellular carcinoma[J]. N Engl J Med, 2020, 382(20): 1894-1905.
[6]	孙恒亮, 濮忠建. 血清甲胎蛋白和三叶因子1水平对原发性肝癌的诊断及预后价值[J]. 中国肝脏病杂志(电子版), 2021, 13(4): 27-37.
[7]	Keam SJ, Duggan S. Donafenib: first approval[J]. Drugs, 2021, 81(16): 1915-1920.
[8]	D'Arrigo P, Tufano M, Rea A, et al. Manipulation of the immune system for cancer defeat: a focus on the t cell inhibitory checkpoint molecules[J]. Curr Med Chem, 2020, 27(15): 2402-2448.
[9]	于明华, 丁晓燕, 陈京龙. 晚期原发性肝癌新一线靶向药乐伐替尼研究进展[J]. 中国肝脏病杂志(电子版), 2023, 15(2): 18-22.
[10]	Montasser A, Beaufrère A, Cauchy F, et al. Transarterial chemoembolisation enhances programmed death-1 and programmed death-ligand 1 expression in hepatocellular carcinoma[J]. Histopathology, 2021, 79(1): 36-46.
[11]	Fischer A, Maccio U, Wang K, et al. PD-L1 and HIF-2α upregulation in head and neck paragangliomas after embolization[J]. Cancers (Basel), 2023, 15(21): 5199.
[12]	张艳, 钟珊, 邓欢, 等. 阿替利珠单克隆抗体联合贝伐珠单克隆抗体一线治疗晚期巨块型肝细胞癌的临床疗效[J]. 中华消化外科杂志, 2022, 21(S1): 35-40.
[13]	冉子坤, 焦天宇, 胡丙洋, 等. 靶向联合免疫新辅助方案治疗巨块型肝癌1例[J]. 中华外科杂志, 2023, 61(4): 338-340.
[14]	Qin S, Bi F, Gu S, et al. Donafenib versus sorafenib in first-line treatment of unresectable or metastatic hepatocellular carcinoma: a randomized, open-label, parallel-controlled phase Ⅱ-Ⅲ trial[J]. J Clin Oncol, 2021, 39(27): 3002-3011.
[15]	Wu FX, Chen J, Bai T, et al. The safety and efficacy of transarterial chemoembolization combined with sorafenib and sorafenib mono-therapy in patients with BCLC stage B/C hepatocellular carcinoma[J]. BMC Cancer, 2017, 17(1): 645.
[16]	Li H, Wang J, Zhang G, et al. Transarterial chemoembolization combined donafenib with/without PD-1 for unresectable HCC in a multicenter retrospective study[J]. Front Immunol, 2023, 14: 1277329.
[17]	Ye T, Shao SH, Ji K, et al. Evaluation of short-term effects of drug-loaded microspheres and traditional transcatheter arterial chemoembolization in the treatment of advanced liver cancer[J]. World J Gastrointest Oncol, 2022, 14(12): 2367-2379.
[18]	李臻, 谢炳灿, 叶书文, 等. 载药微球加载不同药物化疗栓塞治疗肝细胞癌的疗效探讨[J]. 介入放射学杂志, 2022, 31(5): 465-470.
[19]	Shi Z, Wang D, Kang T, et al. Comparison of CalliSpheres® microspheres drug-eluting beads and conventional transarterial chemoembolization in hepatocellular carcinoma patients: a randomized controlled trial[J]. Radiol Oncol, 2023, 57(1): 70-79.
[20]	李臻, 叶书文, 谢炳灿, 等. 不同粒径载药微球化学治疗栓塞治疗肝细胞癌的疗效分析[J]. 中华肝脏病杂志, 2022, 30(6): 612-617.
[21]	Deng L, Sun Y, Wang H, et al. Efficacy and safety of transarterial chemoembolization plus donafenib with or without immune checkpoint inhibitors as the first-line treatment for unresectable hepatocellular carcinoma: a propensity score matching analysis[J]. J Hepatocell Carcinoma, 2024, 11: 29-38.
[22]	琚书光, 周晨, 熊斌. 比较TACE联合阿帕替尼和卡瑞利珠单抗序贯与同步治疗不可切除肝细胞癌的临床效果[J]. 中国研究型医院, 2022, 9(3): 34-39.
[23]	李臻, 李一帆, 余鹏, 等. 经动脉载药微球化疗栓塞治疗大肝癌疗效的影响因素[J]. 2023, 32(8): 781-785.
[24]	Li J, Zhang Y, Ye H, et al. Machine learning-based development of nomogram for hepatocellular carcinoma to predict acute liver function deterioration after drug-eluting beads transarterial chemoembolization[J]. Acad Radiol, 2023, 30 Suppl 1: S40-S52.
[25]	Li X, Qiu M, Wang S, et al. A phase I dose-escalation, pharmacokinetics and food-effect study of oral donafenib in patients with advanced solid tumours[J]. Cancer Chemother Pharmacol, 2020, 85(3): 593-604.

临床特征	年龄（岁）		性别（例）		ECOG评分（分）		肿瘤数量（个）		肿瘤最大径（cm）		AFP（ng/mL）
临床特征	< 55	≥55	男	女	0	1	1	> 1	5～10	> 10	< 400	≥400
数据（例）	5	10	13	2	13	2	9	6	5	10	8	9
临床特征	是否门脉癌栓		Child-Pugh分级		BCLC分期		CNLC分期			DEB-TACE次数（次）
临床特征	是	否	A级	B级	B期	C期	Ⅰb期	Ⅱa期	Ⅲa期	≤2	> 2
数据（例）	9	6	11	4	9	6	2	4	9	10	5

临床特征	年龄（岁）		性别（例）		ECOG评分（分）		肿瘤数量（个）		肿瘤最大径（cm）		AFP（ng/mL）
临床特征	< 55	≥55	男	女	0	1	1	> 1	5～10	> 10	< 400	≥400
数据（例）	5	10	13	2	13	2	9	6	5	10	8	9
临床特征	是否门脉癌栓		Child-Pugh分级		BCLC分期		CNLC分期			DEB-TACE次数（次）
临床特征	是	否	A级	B级	B期	C期	Ⅰb期	Ⅱa期	Ⅲa期	≤2	> 2
数据（例）	9	6	11	4	9	6	2	4	9	10	5

不良反应	1～2级	3级
乏力	6	0
手足综合征	3	1
高血压	3	0
腹泻	3	0
肝功能异常	3	0
免疫性皮疹	0	1
免疫性肺炎	0	1

不良反应	1～2级	3级
乏力	6	0
手足综合征	3	1
高血压	3	0
腹泻	3	0
肝功能异常	3	0
免疫性皮疹	0	1
免疫性肺炎	0	1

Please choose a citation manager

Content to export