| Objective: Liver malignant tumor is a kind of malignant tumors with high incidence and mortality in the world,including primary liver cancer and secondary liver cancer.However,due to the fact that most patients with liver malignant tumors are diagnosed at an intermediate or advanced stage,they cannot be treated with radical surgery.Transarterial chemoembolization(TACE)is one of the most common non-surgical interventions for patients with liver malignant tumors.In the conventional transarterial chemoembolization(c TACE),iodinated oil is used as embolic agents for treatment.Since iodinated oil does not have real drug loading capability and will dissipate with the scouring of blood flow,the local effective drug concentration in the tumor will be reduced.As a new embolic material,Drug-eluting Beads(DEBs)can release chemotherapeutic drugs slowly,prolong the action time of drugs inside the tumor and embolize the blood supply arteries of tumors.Compared with iodinated oil,DEBs can achieve better anti-tumor efficacy and reduce the incidence of systemic adverse effects.However,ischemia and hypoxia in tumor tissue after TACE treatment can increase the level of vascular endothelial growth factor(VEGF),thus promoting neovascularization and inducing recurrence and metastasis of tumors.Bevacizumab is a recombinant humanized monoclonal antibody,which can inhibit the growth and metastasis of tumors by inhibiting the biological effect of VEGF and neovascularization.In this study,we retrospectively analyzed the application of TACE with DEBs loaded with Bevacizumab in the treatment of liver malignant tumors,and explored the efficacy and safety of the treatment method for liver malignant tumors.Methods: The data of 40 patients with liver malignant tumors who attended the hospital for transarterial chemoembolization with DEBs loaded with Bevacizumab from October 2016 to March 2020 were analyzed retrospectively.The laboratory test results,treatment records,imaging data,postoperative adverse effects and follow-up data of all patients were recorded,counted and analyzed before and after treatment for all patients.The efficacy of all patients was evaluated according to the modified response evaluation criteria for solid tumors(m RECIST)at 4 weeks postoperatively,including complete remission(CR),partial remission(PR),stable disease(SD),progressive disease(PD),and disease control rate(DCR).Adverse effects during and after treatment were recorded and evaluated according to the 5 edition of the National Cancer Institute general toxicity standard(CTCAE 5.0).The severity of pain was scored by pain numerical rating scale(NRS),and the overall survival(OS)of patients was observed and recorded.The SPSS 25.0 was used for statistical analysis,the laboratory-related indicators before and after surgery was applied to t-test.Kaplan-Meier method was used to draw the survival curve.Result:1)At 4 weeks after surgery,40 cases of patients with liver malignant tumors were evaluated for efficacy,according to the m RECIST assessment of efficacy,14 achieved PR,20 achieved SD,and 6 achieved PD.The ORR and DCR were 35% and85%,respectively.Among them,14 cases of patients with primary liver cancer were evaluated for efficacy,8 achieved PR and 6 achieved SD.26 cases of patients with secondary liver cancer,6 achieved PR,14 achieved SD and 6 achieved PD.2)In patients with primary liver cancer,The concentration of VEGF decreased gradually at the first day,the third day and the fifth day after surgery.And VEGF concentration was slightly higher at the first day after surgery than that at the day before surgery,and there was no statistically significant difference(P >0.05).In patients with secondary liver cancer,the VEGF concentration was lower at the first day after surgery than that at the day before surgery,and the difference was statistically significant(P < 0.05).3)For patients with DCR,the VEGF concentration decreased gradually at the first day,the third day and the fifth day after surgery.For patients with PD,the VEGF concentration increased at the first day after surgery.The concentration of VEGF of patients with PD was higher than that of patients with DCR at the third day and the fifth day after surgery,and the differences were statistically significant.4)In the primary liver cancer group,the median progression-free survival(m PFS)was8.1 months,the median overall survival(m OS)was 34 months and the one-year survival rate was 85.7%.In the secondary liver cancer group,the median progression-free survival(m PFS)was 3.7 months,the median overall survival(m OS)was 13.7 months and the one-year survival rate was 76.9%.5)After treatment,alanine aminotransferase(ALT),a laboratory index of liver function,increased slightly compared with that before surgery,but there was no statistically significant difference(P>0.05).After treatment,platelet(PLT)decreased slightly compared with that before surgery,but there was no statistically significant(P > 0.05).Moreover,there was no statistically significant difference in creatinine(Cr),aspartate aminotransferase(AST),total bilirubin(TBIL)and white blood cells(WBC)before and after treatment(P > 0.05).6)The adverse reactions were evaluated four weeks after surgery,including mild pain(14/40),moderate pain(3/40),fever(6/40),nausea and vomiting(8/40),fatigue(17/40),bone marrow suppression(3/40),and mild liver function injury(13/40).The above adverse reactions were alleviated after symptomatic support treatment.All patients did not have allergic reactions,gastrointestinal bleeding,hypertension and other adverse reactions,and there was no serious adverse reaction and treatment-related death.Conclusion:DEBs loaded with Bevacizumab can effectively reduce the level of VEGF in patients with liver malignant tumors during the intervention,and it may be a therapeutic method with better efficacy and safety. |
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