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Volume 39 Issue 4
Apr.  2023
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Article Navigation >  Journal of Clinical Hepatology  > 2023  >  39(4): 834-842

Safety and efficacy of camrelizumab added to second-line therapy after drug-eluting bead transarterial chemoembolization combined with apatinib for unresectable hepatocellular carcinoma

DOI: 10.3969/j.issn.1001-5256.2023.04.014

  • Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China

Research funding:

The Co-operation Research Plan of Medical Science and Technology in Henan Province (SBGJ202102100)

More Information
  • Corresponding author: WANG Manzhou, manzhouwang@126.com (ORCID: 0000-0003-3685-4801)
  • Received Date: 2022-08-19
  • Accepted Date: 2022-09-20
  • Published Date: 2023-04-20
    Abstract
  •   Objective  To investigate the safety and efficacy of camrelizumab added to second-line therapy after drug- eluting bead transarterial chemoembolization (DTACE) combined with apatinib for unresectable hepatocellular carcinoma (HCC).  Methods  A retrospective analysis was performed for 89 HCC patients with camrelizumab added to second-line therapy who attended The First Affiliated Hospital of Zhengzhou University from December 2019 to December 2020. The primary endpoints were overall survival (OS) and progression-free survival (PFS) after the application of camrelizumab, and the secondary endpoints were objective remission rate (ORR), disease control rate (DCR), and treatment-related adverse events (TRAEs). The Kaplan-Meier method was used to plot survival curves, the Log-rank test was used for stratified analysis of subgroups based on baseline characteristics, and the influencing factors for prognosis were analyzed.  Results  A total of 89 patients were screened and followed up in this study. The patients were followed up to December 2021, with a median follow-up time of 16 months, a median OS time of 17.0 (95% confidence interval [CI]: 15.3-18.7) months, and a median PFS time of 7.0 (95% CI: 6.2-7.8) months. There were significant differences in OS and PFS between the patients with different ECOG-PS scores, liver function Child-Pugh classes, portal vein invasion, patterns of progression, times of DTACE treatment, durations of oral administration of apatinib, and durations of application of camrelizumab (all P < 0.05). At 3 and 6 months after the application of camrelizumab, ORR was 39.3% and 22.4%, respectively, and DCR was 80.9% and 54.1%, respectively. The univariate analysis using the Log-rank test showed that compared with the patients receiving 0 time of DTACE treatment, the patients receiving 3-4 or 1-2 times of DTACE treatment had significant improvements in median OS [22.0 (95% CI: 21.1-22.9) months and 17.0 (95% CI: 15.8-18.2) months vs 10.0 (95% CI: 7.0-13.0) months, χ2=31.423, P < 0.001] and PFS [10.0 (95% CI: 7.0-13.0) months and 7.0 (95% CI: 6.2-7.8) months vs 3.0 (95% CI: 1.9-4.1) months, χ2=20.741, P < 0.001]; compared with the patients using apatinib for ≤4 months, the patients using apatinib for > 4 months had significant improvements in median OS [21.0 (95% CI: 19.1-22.9) months vs 14.0 (95% CI: 10.4-17.6) months, χ2=19.399, P < 0.001] and PFS [9.0 (95% CI: 7.3-10.7) months vs 5.0 (95% CI: 4.0-6.0) months, χ2=27.733, P < 0.001]; compared with the patients using camrelizumab for ≤5 months, the patients using camrelizumab for > 5 months had significant improvements in median OS [22.0 (95% CI: 20.2-23.8) months vs 13.0 (95% CI: 9.3-16.7) months, χ2=22.336, P < 0.001] and PFS [9.0 (95% CI: 7.0-11.0) months vs 5.0 (95% CI: 4.1-5.9) months, χ2=26.141, P < 0.001]. Post-embolization syndrome was the adverse event after DTACE and resolved after symptomatic treatment. Adverse reactions related to targeted drugs and immunotherapy all resolved after symptomatic supportive treatment, with no grade ≥4 adverse reactions, and no patients withdrew from target-free therapy due to TRAEs.  Conclusion  As for DTACE combined with apatinib in the treatment of unresectable HCC, camrelizumab added after progression has a marked therapeutic efficacy with safe and controllable TRAEs.

     

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