Efficacy Of FOLFOX-HAIC Combined With Targeted Therapy And Immunotherapy For Advanced Hepatocellular Carcinoma

Objective:This study retrospectively analyzed the clinical efficacy and safety of FOLFOX-HAIC and TACE combined with tyrosine kinase inhibitors and immune checkpoint inhibition in the treatment of intermediate and advanced hepatocellular carcinoma to provide a reference for the treatment modality or pathway for patients with intermediate and advanced hepatocellular carcinoma.Methods:Patients with hepatocellular carcinoma treated at the Affiliated Hospital of Youjiang Medical College for Nationalities and the Affiliated Southwest Hospital of Youjiang Medical College for Nationalities from May 2018 to November 2022 were collected retrospectively and met the inclusion/exclusion criteria.Group A received FOLFOX-HAIC+TKI+ICI,and group B received TACE+TKI+ICI.Collecting basic clinical information and treatment-related adverse events in both groups.Efficacy evaluation of target intrahepatic lesions using The Modify Response Evaluation Criteria in Solid Tumors.Chi-square test was applied to compare the differences in objective response and disease control rate between groups A and B.The Kaplan-Meier method was used to plot survival curves to derive the median progression-free survival and median overall survival of the patients.Log-rank test was used to analyze the differences in survival curves.Following the univariate analysis,a multifactorial analysis of the factors affecting the prognosis of patients was conducted by incorporating them into a Cox proportional risk regression model.The National Cancer Institute’s Common Adverse Event Evaluation Criteria were used to judge and grade the adverse events that occurred during treatment,and to compare the incidence and severity of adverse events between patients in Groups A and B.Results:(1)In this study,38 patients were included in Group A and 47 patients in Group B.There was no significant difference in each clinical baseline characteristic between the two groups before treatment(P> 0.05).(2)The overall objective tumour remission rate and disease control rate for patients in the FOLFOX-HAIC+TKI+ICI group(Group A)was 52.63% and76.32%,while the overall objective response rate for patients in the TACE+TKI+ICI group(Group B)was 29.79% and the disease control rate was 55.32%.The overall objective tumour remission rate and disease control rate of patients in Group A were more favourable than those in Group B.The difference was statistically significant(P=0.033,P=0.044).(3)The median progression-free survival was 9.0 months(95% confidence interval: 8.191-9.809)and7.0 months(95% confidence interval: 5.802-8.198)for the two groups respectively,with a statistically significant difference in median progression-free survival between the two groups(P=0.002).Median overall survival was 25.0 months(95% confidence interval:21.376-28.624)and 18.0 months(95% confidence interval: 11.676-24.324)for the two groups,respectively,with a statistically significant difference(P=0.006).(4)The results of the univariate analysis indicated that AFP level before combination therapy,and combination therapy regimen were independent prognostic factors affecting overall survival of patients with advanced hepatocellular carcinoma in this study(P=0.004,P=0.006),and the results of the multi-factor Cox regression model analysis indicated that AFP level before combination therapy,and combination therapy regimen were independent factors affecting overall survival of patients with advanced hepatocellular carcinoma in this study(P=0.020,P=0.027).(5)In terms of treatment safety,no treatment-related deaths occurred in either group.There was no difference in the incidence of adverse reactions between the two groups(P> 0.05).Conclusion:(1)Compared with TACE combined with targeted and immunotherapy,FOLFOX-HAIC combined with targeted and immunotherapy has initially shown promise in the treatment of hepatocellular carcinoma.(2)The results of this study suggest that AFP level before combination therapy and combination therapy regimen are risk factors affecting the prognosis of patients with intermediate to advanced hepatocellular carcinoma.(3)The results of this study suggest that FOLFOX-HAIC combined with targeted and immunotherapy is safe and feasible for the treatment of intermediate and advanced hepatocellular carcinoma.