Real‑world investigation for camrelizumab combined with apatinib in patients with advanced hepatocellular carcinoma

Apatinib, an oral tyrosine kinase inhibitor, combined with camrelizumab, a programmed cell death protein 1 inhibitor, has shown promising treatment efficacy for patients with advanced hepatocellular carcinoma (HCC). However, real-world evidence supporting this combination regimen is limited, and prognostic factors for these patients have not been thoroughly investigated. Therefore, the present real-world study aimed to assess the efficacy and safety of camrelizumab plus apatinib in patients with advanced HCC, and identify prognostic factors associated with response to treatment. A total of 39 patients with advanced HCC who received camrelizumab combined with apatinib were included in the present retrospective study. All patient data, such as treatment response, follow-up outcomes and incidence of adverse events were collected for analysis. The results revealed complete response, partial response, stable disease and progressive disease rates of 25.6, 10.3, 46.2 and 17.9%, respectively. In addition, the objective response and disease control rates were 35.9 and 82.1%, respectively. The median progression-free survival (PFS) was 24.0 months (95% confidence interval, 5.0-43.0). Furthermore, the cumulative PFS rates at 12, 24 and 36 months were 52.8, 44.0 and 39.1%, respectively. However, median overall survival (OS) was not reached during the follow-up period. The OS rates at 12, 24 and 36 months were 72.4, 72.4 and 66.3%, respectively. Multivariate Cox regression analysis also revealed that extrahepatic metastasis was independently associated with higher mortality risk (hazard ratio, 9.217; P=0.049). The most common adverse events were anemia (79.5%), thrombocytopenia (69.2%), leukopenia (64.1%), pain (56.4%), neutropenia (41.0%), fever (33.3%) and hypertension (28.2%). In conclusion, camrelizumab combined with apatinib shows promising treatment efficacy and a manageable toxicity in patients with advanced HCC. Additionally, extrahepatic metastasis could be associated with worse OS in these patients. Nevertheless, due to the small sample size, retrospective and single-arm study design in the current study, further study with a larger sample size, prospective, controlled design is required.