Efficacy And Safety Of Hepatic Arterial Infusion Chemotherapy Combined With Lenvatinib And PD-1 Inhibitors For Advanced Hepatocellular Carcinoma With Portal Vein Tumor Thrombus

Objective:To explore the efficacy and safety of hepatic arterial infusion chemotherapy(HAIC),combined with lenvatinib and programmed cell death-1 in the first-line treatment of advanced hepatocellular carcinoma patients with vascular invasion.Methods:From July 2020 to February 2022,we retrospectively analyzed the clinical data of patients with advanced hepatocellular carcinoma with vascular invasion who received hepatic arterial infusion FOLFOX(oxaliplatin,5-fluorouracil and leucovorin)combined with lenvatinib and PD-1 inhibitors.Kaplan-Meier was used to explore the survival curve,and COX regression model was used to analyze the influence of multiple factors on progression-free survival(PFS).Objective remission rate(ORR),disease control rate(DCR)and incidence of adverse reactions were discussed.Results:The evaluation of treatment effect was according to RECIST1.1.Overall tumor evaluation:Of the 32 patients,ten patients(31.25%)got partial response,eighteen(56.25%)maintained stable disease and four(12.50%)suffered progressive disease.ORR was 31.25% and DCR was 87.5%;Evaluation of intrahepatic lesions: ten(31.25%)got partial response,twenty(62.50%)maintained stable disease and two(6.25%)suffered progressive disease.ORR was 31.25% and DCR was 93.75%;The median progression-free survival was 179 days.Univariate and multivariate Cox analysis showed that the presence or absence of extrahepatic metastases and ChildPugh score were independent prognostic factor of PFS.Adverse events were assessed according to CTCAE5.0.Of the 32 patients,22(68.75%)had adverse reactions.The main symptoms were elevated transaminase(46.87%),thrombocytopenia(40.63%),albumin decrease(28.13%),nausea and vomiting(21.88%),leukopenia(18.76%),abdominal pain(15.63%),hypertension(15.63%)and fever(15.63%).There were seven cases(21.88%)with grade 3 or above:two cases with elevated transaminase(6.25%),leukopenia,thrombocytopenia,nausea and vomiting,abdominal pain and diarrhea were found in one case respectively.Symptoms could be improved after symptomatic treatment,and no treatment-related death was observed.Conclusions:Hepatic arterial infusion chemotherapy combined with lenvatinib and PD-1inhibitors as the first-line treatment for advanced hepatocellular carcinoma with vascular invasion is effective,with relatively tolerable adverse reactions.