Safety And Clinical Efficacy Of TACE Combined With Camrelizumab And Apatinib On Advanced Hepatocellar Carcinoma

Objective: This research aims to retrospectively analyze the relevant clinical data in the treatment of advanced hepatocellular carcinoma（HCC）in our hospital,and explore Whether transcatheter arterial chemoembolization（TACE）combined with Camrelizumab and apatinib is better than TACE with only apatinib in the treatment of advanced HCC.Observe the occurrence of adverse reactions during the medication,and summarize the experience to provide a reference for clinic to improve the quality of patients’ life with advanced HCC and prolong the survival time of them.Methods: The clinical data of patients with advanced HCC in our hospital from January2019 to June 2021 were collected,and 40 cases were enrolled after screening by inclusion and exclusion criteria.According to the treatment method,20 cases treated with TACE combined with Camrelizumab and apatinib were recorded as experimental group,20 cases treated with TACE combined with apatinib were recorded as the control group.Record the general clinical data of the two groups of patients,including personal information and related laboratory examinations,image data,etc.Through the EMR system or telephone follow-up,the tumor response,adverse reactions and survival status of patients after 1 month,3 months,and 6 months of combined treatment were recorded.The objective response rate（ORR）and disease control rate（DCR）,progression-free survival（PFS）and overall survival time（OS）in both groups were statistically analyzed.With P<0.05 as the test level,the difference was statistically significant.Results: 1.General data:There were no significant differences in general information,such as age,liver function,tumor-related conditions and laboratory tests between the two groups（P>0.05）.2.Comparison of local efficacy: After 1 month of combined treatment,the ORR and DCR of the experimental group were 65.0% and 95.0% higher than those of the control group（ORR 50.0% and DCR 85.0%）,and the difference was not statistically significant（P>0.05）.After 3 months,the ORR of the experimental group was 50.0% higher than that of the control group（20.0%）,with statistical significance（P=0.047<0.05）,and the DCR was 85.0% higher than that of the control group,with no statistical significance（P=0.077>0.05）.After 6 months,ORR 45.0% and DCR 80.0% in the experimental group were significantly higher than 15.0% and 50.0% in the control group,with statistical significance（P<0.05）.3.Survival analysis: The effective follow-up times of the two groups was 6-20 months.By the end of the research,3 cases in the control group had no progression,while 6cases in the experimental group.14 cases in the experimental group and 8 cases in the control group whose overall survival time did not reach.K-M method showed that the m PFS of the experimental group was 9.0（95%CI,7.10-10.90）months higher than that of the control group 6.0（95%CI,4.78-7.22）months,and the difference was statistically significant（P=0.029<0.05）.The m OS of the experimental group was not reached,and the m OS of the control group was 11.0（95%CI,8.99-13.01）months.Log-rank test showed statistically significant difference between the two groups（P=0.039<0.05）.4.Drug-related adverse reactions: The adverse reactions in the two groups were mainly analyzed by descriptive statistics.The highest incidence was liver function damage（60.0% in the experimental group vs 50.0% in the control group）,which was mainly manifested as elevated AST.Secondary hypertension（30.0% in the experimental group vs 40.0% in the control group）and hand-foot syndrome（25.0% in the experimental group vs 45.0% in the control group）were more common in the two groups,among which 2 cases of hand-foot syndrome and 1 case of hypertension in the control group were grade III.The most common immune-related adverse reaction in the experimental group was cutaneous capillary hyperplasia（RCCEP）,with an incidence of 45.0%,of which 1 case was grade II.In addition,6 cases（30.0%）had elevated TSH,and 8 cases（40.0%）had elevated myocardial enzymes,all of which were grade I reactions.Conclusion: 1.In the treatment of advanced HCC,TACE combined with Camrelizumab and apatinib has certain advantages in prolonging the PFS and OS of patients compared with TACE with apatinib only.2.The incidence of immune-related adverse reactions is higher after Camrelizumab administration.But most of them are low-grade,which can be improved by symptomatic treatment.In short,TACE combined with Camrelizumab and apatinib is safe and effective in the treatment of advanced HCC.