Abstract 212P
Background
For patients with large unresectable hepatocellular carcinoma (HCC), the effectiveness of conventional transarterial chemoembolization (TACE) remains suboptimal, which necessitates the administration of substantial volumes of chemotherapy drugs and lipiodol, thereby increasing the risk of liver failure and other chemotherapy-related complications. Therefore, we devised a strategy of initial hepatic arterial infusion chemotherapy (HAIC) followed by sequential drug-eluting bead TACE (DEB-TACE). In our treatment design, a lower tumor burden after HAIC facilitated complete embolization of tumor vasculature, and the use of less amount of embolic agents reduced the incidence of liver failure and embolization syndromes. To our knowledge, this is the first study evaluating this bridging strategy of combination FOLFOX-HAIC and DEB-TACE treatment.
Methods
This retrospective study evaluated consecutive patients with unresectable large HCC who received FOLFOX-HAIC combined with sequential DEB-TACE from April 2019 to February 2024. Efficacy was evaluated using the objective response rate (ORR), overall survival (OS), and progression-free survival (PFS); and safety was assessed using the frequency of key adverse events (AEs).
Results
Among the 76 patients included, the median maximum tumor diameter was 12.4 cm (range, 7.0–23.4 cm). The overall ORRs based on mRECIST and RECIST 1.1 criteria were 94.1% and 51.5%, respectively. The 1-, 2-, and 3-year OS rates were 97.2%, 92.6%, and 84.7%, respectively, with a median OS of 28.1 months (95% CI, 22.7–33.4). The 1-, 2-, and 3-year PFS rates were 89.1%, 76.4%, and 64.2%, respectively, with a median PFS of 11.7 months (95% CI, 7.7–15.8). All patients experienced AEs, but only 18.4% experienced grade 3 or 4 AEs, there was no treatment-related mortality.
Conclusions
FOLFOX-HAIC with sequential DEB-TACE demonstrated promising efficacy and safety for patients with unresectable HCC with a maximum tumor diameter of ≥7 cm. This combination strategy can be a new first-line treatment option for these patients, although validation by a multicenter, randomized, controlled phase III clinical trial is required.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
R. Guo.
Funding
This study was supported by the National Natural Science Foundation of China (No. 82303879, No. 82203002, No. 82172579); Science and Technology Planning Project of Guangzhou (No. 2023A04J1777, No. 2023A04J2137); Fostering Program for NSFC Young Applicants (Tulip Talent Training Program) of Sun Yat-sen University Cancer Center (No. TTP-SYSUCC-202313, No. TTP-SYSUCC-202208); Clinical Trials Project (5010 Project) of Sun Yat-sen University (No. 5010-2017009, No. 5010-2023001).
Disclosure
All authors have declared no conflicts of interest.