Abstract
Objective
Current strategies for treating massive hepatocellular carcinoma (HCC) often involve interventional procedures, yet their effectiveness is frequently constrained, and extensive clinical data are still limited. This research aims to assess the safety and efficacy of using lenvatinib in combination with transarterial chemoembolization (TACE) and hepatic arterial infusion chemotherapy (HAIC) for treating massive HCC.
Methods
We conducted a retrospective review of patients who received TACE-HAIC -lenvatinib between January 2022 and January 2023. The study included 31 eligible patients. Lenvatinib therapy commenced within one week post-TACE, with a dosage of either 8 or 12 mg per day based on body weight. Follow-up assessments were carried out 3–4 weeks after the initial intervention. Using dynamic contrast-enhanced CT or MRI, treatment response was assessed following the modified Response Evaluation Criteria in Solid Tumors (mRECIST). Patients who achieved complete response (CR), partial response (PR), or stable disease (SD) continued lenvatinib therapy, while those with progressive disease (PD) underwent additional TACE and HAIC. The progression-free survival (PFS), overall survival (OS), disease control rate (DCR), objective response rate (ORR), and adverse events (AEs) were all calculated. Statistical analysis was conducted using the Kaplan-Meier method.
Results
At 3, 6, 9, and 12 months following treatment, the objective response rates (ORR) were 38.71% (12/31), 51.61% (16/31), 32.26% (10/31), and 25.81% (8/31), respectively. The corresponding disease control rates (DCR) were 90.32% (28/31), 74.19% (23/31), 58.06% (18/31), and 45.16% (14/31). The median PFS was 8.0 months (95% CI,6.4–9.6 months), while the median OS was 15.0 months (95% CI,13.8–16.2 months). Adverse events (AEs) were noted in 90.3% of patients, with hypothyroidism being the most prevalent at 74.2%.
Conclusion
The results of our study suggest that the TACE-HAIC-lenvatinib sequential treatment regimen demonstrates good safety and tolerable levels for the treatment of massive hepatocellular carcinoma (HCC), with the potential to enhance progression-free survival (PFS) and overall survival (OS). This therapeutic approach provides an alternative for such patients, but additional multicenter randomized controlled trials (RCTs) are necessary to confirm its effectiveness and safety.