A Retrospective Study of Hepatic Arterial Infusion Chemotherapy Combined with Tyrosine Kinase Inhibitors and PD-1 Inhibitors in Hepatocellular Carcinoma Patients with Main Portal Vein Tumor Thrombus (VP4)

Xiaolong Wang, Shiguang Chen, Wenchang Yu, Weifu Liu, Zhuting Fang Department of Oncology and Vascular Interventional Therapy, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, 350014, People’s Republic of ChinaCorrespondence: Zhuting Fang, Department of Oncology and Vascular Interventional Therapy,Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, 350014, People’s Republic of China, Email [email protected]: Patients with hepatocellular carcinoma (HCC) involving main portal vein tumor thrombosis (Vp4) face a dismal prognosis with limited treatment options. While combination therapy comprising hepatic arterial infusion chemotherapy (HAIC), tyrosine kinase inhibitors (TKIs), and PD-1 inhibitors has emerged as a potential strategy, real-world clinical data regarding its efficacy and safety in this subset of patients remain scarce.Methods: This retrospective study enrolled 35 Vp4 HCC patients who received HAIC combine with TKI and PD-1 inhibitor. Treatment response was evaluated according to mRECIST and RECIST1.1. Survival outcomes including progression-free survival (PFS) and overall survival (OS) were analyzed using the Kaplan–Meier method, and independent prognostic factors were identified via Cox regression analyses.Results: Of 35 patients (mean age 52.7 ± 8.3 years, 97.1% male, 97.1% HBV-infected), 37.1% had extrahepatic metastasis and 57.1% had ≥ 4 tumors. After a median follow-up of 313 days (IQR, 177.5– 464.5), the objective response rate (ORR) by mRECIST was 60.0%. Median OS and PFS were 313 days (95% CI: 257.5– 368.5) and 204 days (95% CI: 153.9– 254.1) respectively. Hepatic vein tumor thrombus/inferior vena cava tumor thrombus (HVTT/IVCTT) independently predicted worse PFS (HR = 2.860, p = 0.023) and OS (HR = 3.482, p = 0.007), and tumor number ≥ 4 predicted inferior OS (HR = 2.454, p = 0.020). Grade 3– 4 AEs occurred in 45.7% of patients, most commonly elevated AST (34.3%), with no grade 5 events.Conclusion: The combination of HAIC, TKI, and PD-1 inhibitor demonstrates encouraging antitumor activity and a manageable safety profile in patients with Vp4 HCC, indicating its potential as an effective treatment option for this clinically challenging population.Keywords: hepatocellular carcinoma, hepatic arterial infusion chemotherapy, portal vein