Journal Article

Sequential vs. concurrent systemic therapies in combination with FOLFOX-HAIC for locally advanced hepatocellular carcinoma: a single-center, real-world cohort study

Zhang, Yaojun, Yang, Zhenyun, Zeng, Huilan, Sun, Liyang, Xie, Wa, Zhou, Zhongguo, Chen, Minshan, Hu, Dandan, Pan, Yangxun, Hu, Zhiwen

2024

Overview

Background Tri-combination therapy based on hepatic arterial infusion chemotherapy (HAIC) of infusion fluorouracil, leucovorin, and oxaliplatin (FOLFOX-HAIC) plus immune checkpoint inhibitors (ICIs) and tyrosine kinase inhibitors (TKIs) for the locally advanced hepatocellular carcinoma (HCC) patients have been proven effective. However, whether it was best for these HCC patients to start with the most potent therapeutic pattern was still under debate. This retrospective study evaluated the efficacy and safety of FOLFOX-HAIC combined with systemic therapies in the patterns of sequential and concurrent schedules. Methods This real-world study included 117 unresectable HCC patients who initially received either FOLFOX-HAIC monotherapy (HAIC group, n  = 44) or concurrent ICIs and TKIs (ConHAIC group, n  = 73) from March 2020 and June 2022, during the period of FOLFOX-HAIC monotherapy in HAIC group, patients in the HAIC group ( n  = 30) experienced progressive disease (PD) would have their treatment pattern converted from the FOLFOX-HAIC monotherapy to the combination of FOLFOX-HAIC plus ICIs and TKIs sequentially (SeqHAIC group). The progression-free survival (PFS) and overall survival (OS), as primary outcomes, were compared between patients in the SeqHAIC and ConHAIC groups. Results The median follow-up time of the SeqHAIC group was 24.92 months (95% CI, 12.74–37.09 months) and of the ConHAIC group was 17.87 months (95% CI, 16.85–18.89 months) and no significant difference was observed in both PFS (HR, 1.572; 95% CI, 0.848–2.916; p  = 0.151) and OS (HR, 1.212; 95% CI, 0.574–2.561; p  = 0.614) between the SeqHAIC and the ConHAIC groups. As for the tumor responses, there was no significant difference between the two groups regarding tumor responses, overall response rates ( p  = 0.658) and disease control rates ( p  = 0.641) were 50.0%, 45.2%, and 83.3%, 89.0% for the SeqHAIC and the ConHAIC groups, respectively. Conclusion Our study revealed that sequential systemic ICIs and TKIs in combination with FOLFOX-HAIC provides similar long-term prognosis and better tolerability compared to concurrent therapy for locally advanced HCC patients. Prospective studies with a larger sample size and longer follow-up are required to validate these findings.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: 5-Fluorouracil / Adult / Aged / Antineoplastic Combined Chemotherapy Protocols - adverse effects / Antineoplastic Combined Chemotherapy Protocols - therapeutic use / Biomedical and Life Sciences / Biomedicine / Cancer Research / Cancer therapies / Carcinoma, Hepatocellular - drug therapy / Carcinoma, Hepatocellular - mortality / Carcinoma, Hepatocellular - pathology / Chemotherapy / Chemotherapy, Combination / Combination therapy / Disease / Disease control / Drug therapy / Female / Fluorouracil - administration & dosage / Fluorouracil - therapeutic use / Health Promotion and Disease Prevention / Hepatic artery infusion chemotherapy / Hepatocellular carcinoma / Hepatoma / Humans / Immune checkpoint inhibitors / Immune Checkpoint Inhibitors - administration & dosage / Immune Checkpoint Inhibitors - adverse effects / Immune Checkpoint Inhibitors - therapeutic use / Infusions, Intra-Arterial / Leucovorin - administration & dosage / Leucovorin - therapeutic use / Liver cancer / Liver Neoplasms - drug therapy / Liver Neoplasms - mortality / Liver Neoplasms - pathology / Magnetic resonance imaging / Male / Medical records / Medicine/Public Health / Methods / Middle Aged / Oncology / Organoplatinum Compounds - administration & dosage / Organoplatinum Compounds - therapeutic use / Oxaliplatin / Oxaliplatin - administration & dosage / Oxaliplatin - therapeutic use / Patient outcomes / Patients / Protein Kinase Inhibitors - administration & dosage / Protein Kinase Inhibitors - adverse effects / Protein Kinase Inhibitors - therapeutic use / Real-world cohort study / Response rates / Retrospective Studies / Statistical analysis / Surgery / Surgical Oncology / Survival / Survival analysis / Toxicity / Tumors / Tyrosine kinase inhibitors