HAIC Modified Regimen Combined With Rivatinib And Karelizumab In The Treatment Of BCLC Phase C Clinical Study Of Primary Hepatocellular Carcinoma

Background Primary hepatocellular carcinoma(HCC)is one of the most common malignant tumors in clinic.Most of the patients in our country are in the middle and late stage when they see a doctor.The problems such as low resection rate and easy recurrence after surgery seriously affect the survival period of patients.According to the Barcelona guidelines for clinical liver cancer staging(BCLC staging),transcatheter arterial chemoembolization(TACE),hepatic arterial infusion chemotherapy(HAIC),and systemic therapy are all the first-line and second-line therapies for BCLC B/C.HAIC takes advantage of the blood supply characteristics of liver malignant tumors and continuously infuses chemotherapy drugs through hepatic artery,which can increase the concentration of local effective chemotherapy drugs and reduce the concentration of chemotherapy drugs in peripheral blood to reduce side effects.However,the existing HAIC lacks a unified standard,and it is mostly implemented with reference to the drugs,dosage and course of treatment of the systemic chemotherapy scheme,of which the FOLFOX4 scheme based on oxaliplatin is the most widely used.However,in clinical practice,HAIC treatment based on FOLFOX4 standard protocol often has to be terminated due to patients’ intolerance,which is difficult to achieve the treatment purpose and affects the prognosis of patients.In view of this,this paper aims to improve the technology of FOLFOX4 standard scheme in the application of HAIC in the light of the problems of large dose of chemotherapy drugs,long perfusion time,strong toxicity and side effects,and patient intolerance,and explore the feasibility,safety and clinical efficacy of the HAIC modified scheme combined with revalitinib and PD-1,in order to provide reference for the HAIC combined treatment of HCC.Objective To investigate the feasibility,safety and clinical efficacy of the modified HAIC regimen combined with revalitinib and carlizumab in the treatment of BCLC stage C primary hepatocellular carcinoma.Methods Sixty patients with BCLC stage C HCC cancer from August 20 2 0 to August2022 were selected as the study subjects and randomly divided into improved group and standard group with 3 0 cases.In the improved group,the HAIC regimen was followed by oxaliplatin 75mg/m2,calcium folinate 300mg/m2,5-fluorouracil 1.5g/m2,continuous perfusion for 2 4 hours,and the course of treatment was once every 3 weeks;HAIC in the standard group took oxaliplatin 100mg/m2,calcium folinate 400mg/m2,5-fluorouracil 3g/m2 according to FOLFOX 4 protocol,and continuously perfused for 4 8 hours in turn,with a course of treatment once every 3 weeks.TACE was performed routinely before HAIC in both groups,and after HAIC,revalitinib 4-8 mg/d was taken orally;Karelizumab 200 mg was given intravenously,and the course of treatment was once every 3 weeks.Follow up the progression-free survival time(PFS),median total survival time(m OS),preoperative and postoperative liver imaging changes,liver and kidney function,blood routine and other laboratory indicators of the two groups,and then compare and analyze the clinical efficacy and safety of the two groups.Results According to the m RECIST standard,in the modified group,there were 4 cases of CR,16 cases of PR,1 case of SD,and 16 cases of PD three months after operation.The objective response rate was ORR 66.7%,and the clinical benefit rate was CBR 470%;In the standard group,there were 5 cases of CR,17 cases of PR,2 cases of SD,10 cases of PD,73.3% of ORR and 80% of CBR;The PFS and m OS of the improved group were 8 months and 18 months respectively;The PFS of the standard group was 9 months and the m OS was1 5 months.There was no significant difference in PFS and m OS between the two groups(P>0.05);The liver and kidney function damage,bone marrow suppression and coagulation function abnormality in the improved group were lower than those in the standard group(P<0.05).Conclusion According to the m RECIST standard,in the modified group,there were 4cases of CR,16 cases of PR,1 case of SD,and 16 cases of PD three months after operation.The objective response rate was ORR 66.7%,and the clinical benefit rate was CBR 470%;In the standard group,there were 5 cases of CR,17 cases of PR,2 cases of SD,10 cases of PD,7 3.3% of ORR and 80% of CBR;The PFS and m OS of the improved group were 8 months and 18 months respectively;The PFS of the standard group was 9 months and the m OS was1 5 months.There was no significant difference in PFS and m OS between the two groups(P>0.05);The improved group was lower than the standard group in partial liver and kidney function damage(P<0.05).