Safety and Efficacy of Camrelizumab Combined with Apatinib for Advanced Hepatocellular Carcinoma with Portal Vein Tumor Thrombus: A Multicenter Retrospective Study

• Main Authors: Yuan G, Cheng X, Li Q, Zang M, Huang W, Fan W, Wu T, Ruan J, Dai W, Yu W, Chen M, Guo Y, Hu X, Chen J
• Format: Article
• Language: English
• Published: Dove Medical Press 2020-12-01
• Series: OncoTargets and Therapy
• Subjects: hepatocellular carcinoma; hcc; camrelizumab; apatinib; overall survival; os
• Online Access: https://www.dovepress.com/safety-and-efficacy-of-camrelizumab-combined-with-apatinib-for-advance-peer-reviewed-article-OTT

Guosheng Yuan,1,* Xiao Cheng,1,* Qi Li,1,2 Mengya Zang,1 Wei Huang,3 Wenzhe Fan,4 Tao Wu,5 Jian Ruan,6 Wencong Dai,1 Wenxuan Yu,1 Mian Chen,7 Yabing Guo,1 Xiaoyun Hu,1 Jinzhang Chen1,2 1Department of Infectious Diseases and Hepatology Unit, Nanfang Hospital, Southern Medical University, Guangzhou, People’s Republic of China; 2Department of Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, People’s Republic of China; 3Department of Oncology, ShunDe Hospital, Southern Medical University, Foshan, People’s Republic of China; 4Department of Interventional Oncology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People’s Republic of China; 5Department of Infectious Disease, Hainan General Hospital, Haikou, People’s Republic of China; 6Department of Medical Oncology, The First Affiliated Hospital, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China; 7Transplant Immunology Laboratory, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Headington, Oxford, UK*These authors contributed equally to this workCorrespondence: Jinzhang Chen; Xiaoyun HuDepartment of Infectious Diseases and Hepatology Unit, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Ave, Guangzhou, Guangdong 510515, People’s Republic of ChinaTel + 8620-13802522545; + 8620-15625010540Fax + 8620-62787430; + 8620-62787430Email [e-mail]; [e-mail]: Previous trials demonstrated that anti-angiogenesis or anti-programmed death protein 1 (PD-1) monotherapy showed unsatisfied effect in advanced hepatocellular carcinoma (HCC). No study existed that focus on the effects of camrelizumab and apatinib (“C+A”) combination therapy for HCC patients with the location and extent of portal vein tumor thrombus (PVTT) as the main variable being assessed. This study was to compare the efficacy and tolerability of “C+A” for HCC patients with PVTT.Methods: We retrospectively analyzed patients with advanced HCC and PVTT who underwent “C+A” therapy in a multicenter retrospective cohort from Jan 2019 to July 2020. Outcomes of patients who underwent “C+A” were analyzed by using the Kaplan–Meier method according to types of PVTT: PVTT in the main portal vein (type A), PVTT in the first-order portal vein branch (type B), and PVTT in second- or lower-order portal vein branches (type C).Results: Sixty-three patients were finally included and the mean duration of follow-up was 12.6 ± 4.5 months. The objective response rate (ORR) and disease control rate (DCR) for the whole cohort were 44.0% and 75.0%, respectively. The median overall survival (OS), progression-free survival (PFS) and time to progression (TTP) were 14.8 months, 11.8 months and not yet reached (NR), respectively. Patients with type B (OS, 15.9 months; PFS, 14.0 months; TTP, NR) or type C (OS, 16.0 months; PFS, 14.9 months; NR) PVTT appear to have better survival benefits compared with type A (OS, 5.8 months; PFS, 5.0 months; TTP, 7.0 months). Along with AFP, the absence of main PVTT was an independent predictive factor for survival at uni- and multivariate analysis.Conclusion: Camrelizumab and apatinib yielded a promising outcome in patients with advanced HCC who developed a tumor thrombus in the first lower-order portal vein branches and was generally safe and had manageable side effects.Keywords: hepatocellular carcinoma, HCC, camrelizumab, apatinib, overall survival, OS