Abstract 211P
Background
Various conversion therapy options have become available to patients with unresectable hepatocellular carcinoma (HCC), but which conversion therapy is optimal for which type of patient is controversial. This study compared the efficacy and safety of transarterial chemoembolization (TACE) alone or combined with immune checkpoint (ICIs) and tyrosine kinase inhibitors (TKIs).
Methods
Data were retrospectively compared for patients with initially unresectable HCC at 20 medical centers in China who underwent conversion therapy consisting of TACE alone (n = 459) or combined with ICIs and TKIs (n = 343) between January 2019 and June 2023. The two groups were compared in terms of overall survival, progression-free survival, tumor response, adverse events, conversion to surgery and pathologic response after surgery.
Results
Compared to the group that received TACE alone, the group that received triple conversion therapy showed significantly higher rates of OS at 1 year (86.2 vs 65.9%), 2 years (67.9 vs 45.4%) and 3 years (56.2 vs 31.1%) (HR 0.43, 95%CI 0.35–0.53, p < 0.001). In addition, triple therapy was associated with significantly longer median PFS (15.9 vs 8.0 months, p < 0.001). These results were confirmed in matched subsets of patients from each group. However, subgroup analysis confirmed the results only for patients with HCC in intermediate or advanced stages, not in an early stage. Those who received triple conversion therapy had a significantly higher rate of surgery after conversion therapy (36.4 vs 23.5%, p < 0.001). Among those who underwent surgery after conversion therapy, triple therapy was associated with a significantly higher rate of complete tumor response (32.1 vs 11.1%, p < 0.001). It was associated with significantly higher frequency of serious adverse events (35.6 vs 27.0%, p = 0.009).
Conclusions
Combining TACE with ICI and TKI was associated with better survival and conversion efficacy than TACE alone among patients with intermediate or advanced unresectable HCC.
Clinical trial identification
NCT06405321.
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.