Abstract 205P
Background
Transarterial chemoembolization (TACE) is a first-line therapy for patients with intermediate-stage hepatocellular carcinoma (HCC), although its survival benefits are modest. The CHANCE2202 study aimed to investigate clinical outcomes of combining TACE with immune checkpoint inhibitors (ICIs) and anti-vascular endothelial growth factor antibody/tyrosine kinase inhibitors (TACE-ICI-VEGF) compared to TACE alone as a first-line treatment for intermediate-stage HCC.
Methods
CHANCE2202 was a nationwide, multicenter, retrospective cohort study including patients with intermediate-stage HCC who received either TACE-ICI-VEGF or TACE monotherapy between January 2018 and December 2022 in China. The study design followed the target trial emulation framework, employing stabilized inverse probability of treatment weighting (sIPTW) to minimize biases. The co-primary outcomes were overall survival (OS) and progression-free survival (PFS) per mRECIST.
Results
A total of 941 patients were included in the analysis, with 308 (32.7%) receiving TACE-ICI-VEGF treatment and 633 (67.3%) receiving TACE monotherapy. The median follow-up was 25.5 months and 25.8 months, respectively. After applying sIPTW, the baseline characteristics between the two groups were well-balanced. The median OS was 32.8 months (95% CI 31.1–40.6) with TACE-ICI-VEGF and 23.3 months (95% CI 21.7–26.1) with TACE (adjusted hazard ratio [aHR] 0.56, 95% CI 0.44-0.71; p<0.001). The median PFS was 18.7 months (95% CI 16.2–23.4) and 12.9 months (95% CI 11.8–14.3) in the respective treatment groups (aHR 0.66, 95% CI 0.55–0.79; p<0.0001) per mRECIST. Patients in the TACE-ICI-VEGF group had a higher objective response rate (ORR) per mRECIST (60.7% vs 44.9%, p< 0.0001). Grade ≥3 adverse events occurred in 64 patients (20.8%) in the TACE-ICI-VEGF group and 43 patients (6.8%) in the TACE group.
Conclusions
Combining TACE to ICIs and anti-VEGF antibody/TKIs significantly improves clinical outcomes than TACE alone and represents a promising first-line treatment option for patients with intermediate-stage HCC.
Clinical trial identification
NCT05332496.
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
The study was supported by National Natural Science Foundation of China (82130060, 61821002), National Key Research and Development Program (2018YFA0704100, 2018YFA0704104), Jiangsu Provincial Medical Innovation Center (CXZX202219), Collaborative Innovation Center of Radiation Medicine of Jiangsu Higher Education Institutions, and Nanjing Life Health Science and Technology Project (202205045).
Disclosure
All authors have declared no conflicts of interest.