Analysis Of The Clinical Effect Of TACE Combined With Lenvatinib And PD-1 Inhibitor On Advanced Hepatocellular Carcinoma

Objective:Our research seeks to explore the therapeutic effectiveness and security of TACE in conjunction with lenvatinib and PD-1 inhibitors for treating advanced,incurable hepatocellular carcinoma.By analyzing pertinent clinical data from our hospital retrospectively,we hope to givemore information for the treatmentof this malady.Methods:Aretrospective examination of clinical data from 49 patients with advanced hepatocellular carcinoma admitted to the First Affiliated Hospital of Gannan Medical University,spanning from December 2020 to December 2022,was conducted by us.The patients was split into two groups based on whether they had received PD-1 treatment,The experimental group were given TACE in combination with lenvatinib and PD-1 inhibitors,while the control group only received TACE in combination with lenvatinib.Data on both groups,including personal information,clinical data,laboratory examination,imaging,and related survival information,was gathered.At 3 and 6 months post-combination treatment,the m RECIST criteria was employed to assess the tumor’s advancement,and the ORR and DCR between the two groups werethen compared.We kept tabs on theduration of the patient’s life and any adverse reactions.SPSS 26.0 software was employed to conduct a statistical analysis.AP value of less than 0.05was deemed to be statistically significant.Results:No noteworthy disparities existed between the two groups of patients prior to TACE treatment in terms of age,gender,Child-Pugh classification,alpha-fetoprotein(AFP)level,hepatitis B virus infection,BCLC classification,ECOG performance status,extrahepatic metastasis,as well as portal vein invasion,liver cirrhosis,tumor morphology,CNCL staging,TACE technique.The baseline characteristics between the two groups were comparable,as indicated by laboratory test results such as ALT,AST,total bilirubin,albumin,red blood cell count,white blood cell count,hemoglobin,platelet count,and prothrombin time(all P>0.5).No significant difference was found between the experimental and control groups in terms of the mean number of TACE sessions,with the former averaging 3.52±1.12 and the latter 3.38±1.13(P>0.5).No noteworthy disparities in the occurrence of adverse events such as hepatic pain,fever,nausea,vomiting,and anorexia after TACE treatment were seen between the two groups(P>0.05),and no serious adverse reactions or complications related to TACE treatment were noticed in either group during the follow-up period.The experimental group’s average lenvatinib use was 8.96±4.06 months,while the control group’s was 7.35±3.11 months,with no noteworthy distinction between the two groups(P>0.05).After three months of combined treatment,the ORR and DCR in the experimental group were 34.6%and 88.5%,respectively,while the control group had 8.6%and 78.3%.The experimental group’s ORR was significantly greater than that of the control group(χ2=4.71,P=0.030).No significant difference in DCR was observed,with a value of 0.05 or less.Six months post-treatment,the ORRand DCR ofthe experimental group were 42.6%and 84.6%,respectively,while the control group’s figures were13%and 56.5%.The experimental group exhibited a significantly higher ORR and DCR than the control group(ORR:χ~2=6.299,P=0.012<0.05;DCR:χ~2=4.720,P=0.030<0.05),with statistically significant differences.Confirming that TACE combined with lenvatinib and camrelizumab is superior to TACE combined with lenvatinib alone in terms of ORR and DCR.At the conclusion ofthe follow-up,all patients had been adequately monitored,with 11(42.3%)fatalities in the experimental group and 17(73.9%)fatalities in the control group.The experimental group’s median PFS was 11.0(95%CI,9.50-12.50)months,significantly higher than the control group’s 7.0(95%CI,5.44-8.55)months(P=0.005<0.05),demonstrating a statistically significant difference in progression-free survival between the two groups.The experimental group’s median OS was significantly higher than the control group’s,at 17.0(95%CI,13.7-20.3)months compared to 14.0(95%CI,11.9-16.1)months(P=0.030).Based on survival data analysis,it can be concluded that TACE combined with lenvatinib and camrelizumab is more effective than TACE combined with lenvatinib alone in prolonging the PFS and OS of patients with intermediate to advanced HCC.Reactive capillary endothelial proliferation syndrome(RCCEP)is a skin adverse reaction that is more common and unique to the PD-1 antibody camrelizumab,with an incidence of 42.3%in the experimental group.In the experimental group,46%,21.7%,and 13%of individuals had high blood pressure,hand-foot syndrome,and anorexia respectively,compared to 34.8%,21.1%,and 13.0%in the control group;however,no statistically significant differences were observed between the two groups(P>0.05)for other adverse reactions.No noteworthy disparity in the occurrence of adverse reactions between thetwo sets of patients is thus evident.Conclusion:The combination of TACE,lenvatinib,and camrelizumab has been shown to have a considerable effect on tumor response,with a higher objective response rate and disease control rate than TACE and lenvatinib alone.This treatment strategy can significantly enhance the prognosis of those with advanced hepatocellular carcinoma,leading to an increase in both progression-free survival and overall survival.Although most patients experienced adverse reactions,the majority were one or two grade and a few three-grade reactions could be managed and relieved through targeted treatment.The clinical efficacy of TACE plus lenvatinib and camrelizumab for inoperable advanced hepatocellular carcinoma is significant,andthe adverse reactions are manageableand safe.