Efficacy Analysis Of Hepatic Arterial Infusion Chemotherapy Enhanced Sorafenib Combined With Camrelizumab In The Treatment Of Advanced Hepatocellular Carcinoma

Purpose:Conversion therapy is gradually emerging in the treatment of advanced hepatocellular carcinoma(HCC),but there is still a lack of research reports on hepatic arterial infusion chemotherapy(HAIC)combined immunotherapy and targeted therapy.Based on the different anti-tumor mechanisms of the three different treatment regimens,the purpose of this study was to explore the efficacy and safety of HAIC combined with sorafenib and camrelizumab compared with sorafenib combined with camrelizumab for advanced HCC.Methods:The study included patients with unresectable advanced hepatocellular carcinoma who met the inclusion criteria and were treated at the First Affiliated Hospital of Nanchang University from September 2020 to June 2021,among them,31 patients in group A received HAIC combined with sorafenib and camrelizumab,and 28 patients in group B received sorafenib combined with camrelizumab.After received the therapy,tumor response was assessed according to Response Evaluation Criteria in Solid Tumors(RECIST version 1.1)and m RECIST,and survival curves were drawn according to the Kaplan-Meier method to calculate Progression-free Survival(PFS)and Overall Survival(OS).Treatment-related adverse events were assessed based on the National Cancer Institute Common Terminology Criteria for Adverse Events(version 5.0).Results:In group A,the best ORR after treatment was 61.3%(95%CI: 43.8%-76.3%)based on m RECIST criteria,while the best ORR based on RECIST 1.1 was 19.4%(95%CI: 9.2%-36.3%);For group B,the best ORR after treatment was 28.6%(95%CI: 15.3%-47.1%)according to m RECIST criteria and 17.9%(95%CI:7.9%-35.6%)according to RECIST 1.1),and there was a significant difference in ORR between the two groups according to m RECIST criteria(P=0.012).After a median follow-up time of 11.9 months,more than half of the patients in group A were alive,so the median OS was not reached,but the median OS in arm B was 8.4 months;The median PFS of patients in group A was 6.6 months,and the median PFS of patients in group B was 3.8 months,with a statistically significant difference(p=0.030);The conversion rates of the two groups were 22.6% and 7.1%,respectively,which did not reach statistical significance(p = 0.100).Subgroup analysis showed that patients with Child-Pugh A,BCLC B,no macroscopic portal vein tumor thrombus(PVTT)and patients who did not stop using sorafenib had better median PFS.All patients had adverse events of varying degrees,he most common adverse reactions were increased alanine aminotransferase,abdominal pain,increased aspartate aminotransferase,hand-foot skin reactions(HFSR),leukopenia and reactive cutaneous capillary endothelial hyperplasia(RCCEP),including 1 case of grade Ⅳadverse events(liver failure)in group A,and no grade Ⅴ adverse events were reported;There was no significant difference in most adverse reactions between the two groups,but in abdominal pain(64.5% vs 21.4%,p = 0.001)and pleural effusion(41.9% vs 10.7%,p = 0.007),significant differences were found between the two different treatment strategies.Conclusions:HAIC combined with sorafenib and camrelizumab showed meaningful efficacy than sorafenib combined with camrelizumab in the treatment of advanced HCC.However,this treatment plan had a great impact on the patient’s liver function,and might bring relatively severe local symptoms.