Abstract
Background and Aims: To compare the efficacy and safety of hepatic arterial-infusion chemotherapy (HAIC) combined with targeted therapy and PD-(L)1 blockades (triple therapy), sequentially (SE) or simultaneously (SI), in the treatment of BCLC stage C hepatocellular carcinoma (HCC).
Approach and Results: From January 1, 2018, to June 1, 2022, 575 patients with BCLC stage C HCC who underwent SE or SI triple therapy were retrospectively enrolled. Propensity score matching (PSM; 1:1) was performed to eliminate possible confounder imbalances across cohorts. We used the Kaplan–Meier method and a log-rank test to compare overall survival (OS) and progression-free survival (PFS) rates between the SI and SE groups. The tumor response and the incidence of adverse events (AEs) was reported. After PSM, 182 patients in each of the two groups were matched. Median OS in the SI group was significantly longer than that in the SE group (28.8 vs. 16.1 months; P= 0.002). Median PFS was significantly improved in the SI versusSE group (9.6 vs. 7.0 months; P= 0.01). The objective response rate (ORR) based on the mRECIST was higher in the SI group (58% vs. 37%; P < 0.001). Total incidences of grade 3–4 AEs were 111/182 (60.9%) and 128/182 (70.3%) in the SE and SI groups, respectively. No grade 5 AEs were reported in either group.
Conclusions: Simultaneous HAIC plus targeted therapy and PD-(L)1 blockades significantly improved outcomes compared with the sequential regimen in patients with BCLC stage C HCC, with no unexpected AEs.
Clinical relevance statement: The patients received hepatic arterial-infusion chemotherapy combined with targeted therapy and PD-(L)1 blockades simultaneously have better prognosis than sequentially.