Objective To evaluate the efficacy and safety of mFOLFOX-based hepatic arterial infusion chemotherapy(HAIC)combined with tyrosine kinase inhibitors(TKIs)and immune checkpoint inhibitors(ICIs)in the treatment of advanced hepatocellular carcinoma(HCC)complicated by portal vein tumor thrombus(PVTT).Methods The clinical data of 37 patients with HCC complicated by PVTT,who received mFOLFOX-based HAIC combined with TKI and ICI at the Department of Intervention,Affiliated Cancer Hospital of Harbin Medical University of China between January 2021 and January 2023,were retrospective analyzed.The primary endpoint was the objective remission rate of PVTT response,and the secondary endpoints included the 6-month survival rate,one-year survival rate,and overall survival(OS).The treatment-related adverse events and complications were evaluated.PVTT response was assessed using ITK-SNAP software,life table was used to calculate 6-month and one-year survival,Kaplan-Meier survival curve was used to assess overall OS,and logistic regression analysis and Cox regression analysis were used to analyze the risk factors associated with PVTT response and OS.Results Of the 37 patients,complete resolution of PVTT volume(CR)was obtained in 7(18.92％),and reduction of PVTT volume over 50％was obtained in 21(56.76％).The objective remission rate(ORR)of PVTT was 75.68％.The 6-month survival rate was 89％,the one-year survival rate was 66％,and the median OS was 15.8 months.Univariate analysis indicated that cavernous degeneration of portal vein(CTPV)was correlated with PVTT response(P=0.010).The Child-Pugh score(P=0.010)and the presence of PVTT response(P=0.004)to treatment were the important factors for predicting OS.Multivariate analysis revealed that the preoperative volume of cancer thrombus(P=0.033),cavernous degeneration of portal vein(P=0.007)were the important factors for predicting the PVTT response,and the Child-Pugh score(P=0.035)and the presence of PVTT response during treatment(P=0.015)were the important factors for predicting OS.The most common adverse reactions related to HAIC were oxaliplatin-related pain(n=30,80％)and thrombocytopenia(n=22,59％),among them 10patients(27％)developed grade Ⅲ painand4patients(11％)developed grade Ⅲ thrombocytopenia.The pain could be alleviated by slowing down the pump velocity and corresponding pain relief treatment.The targeted therapy and immunotherapy-related common adverse reaction was hand and foot reactions(n=16,45％),among them 6 patients(16％)developed grade Ⅲ hand and foot reactions.Conclusion FOLFOX-based HAIC combined with targeted therapy and immunotherapy can obtain a 75.68％ORR of PVTT,which provides more therapeutic options for intrahepatic tumors.
维普
万方数据