Efficacy of pembrolizumab combined with lenvatinib conversion therapy followed by sequential radical surgery in treatment of initially unresectable liver cancer
Objective To investigate the efficacy of pembrolizumab combined with lenvatinib followed by radical surgery in treatment of patients with initially unresectable liver cancer.Methods A total of 112 patients with initially unresectable liver cancer treated in 3201 Hospital Affiliated to Xi'an Jiaotong University School of Medicine from January 2020 to January 2023 were selected as the research subjects.According to the patient's treatment plan,the pembrolizumab conversion therapy sequence was performed.Patients undergoing radical surgery were included in the monotherapy group(n=53),and those receiving conversion therapy with pembrolizumab combined with lenvatinib followed by radical surgery were included in the combination group(n=59).The effect of conversion therapy was investigated in the monotherapy group and the combination group and the pathological results of the two groups after radical surgery were also analyzed.Follow-up investigation was conducted in the patients(the follow-up time was until February 29,2024),and Kaplan-Meier survival curve analysis was performed to determine the prognosis of patients in both groups.Results There was no statistically significant difference in the total effective rate of conversion therapy between the monotherapy group(32.08%)and the combination group(42.37%)(χ2=1.263,P>0.05).Furthermore,there was no statistically significant difference between the monotherapy group and the combination group(27.12%vs 62.71%)in the proportion of pathological complete response and pathological residual tumor≤10%after radical surgery(24.53%vs 60.38%)(χ2=0.098,0.064,both P>0.05).No significant difference was found in progression-free survival rate between the monotherapy group(77.36%)and the combination group(86.44%)(χ2=1.570,P>0.05).The overall survival rate,median survival time and median progression-free survival time of the monotherapy group were 60.37%,13.06 months and 4.78 months,respectively.They were 77.97%,being not reached and 9.83 months in the combination group(χ2=4.0855,4.516,3.773,all P<0.05).There were no uncontrolled adverse drug reactions(ADRs)of grade 3 or above before radical surgery in both groups.Meanwhile,there were no Clavien-Dindo grade 3 or above complications after surgery and no perioperative deaths.There was no significant difference in ADR between the monotherapy group(75.47%)and the combination group(72.88%)(χ2=0.098,P>0.05).Conclusion Pembrolizumab combined with lenvatinib conversion therapy followed by sequential radical surgery has a higher long-term survival benefit than pembrolizumab alone after conversion therapy followed by radical surgery,and ADRs are less likely to occur.Therefore,it can be used as a treatment option for patients with initially incurable liver cancer.
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