Clinical efficacy on downgrading transformation with immune and targeted regimens for unresectable，advanced hepatocellular carcinoma in a real-world setting
ZHANG Xiaoyan1 LI Zuo′an2 SHEN Yang1 CHEN Ping1 LI Jianping1▲#br#
1. Department of Oncology, Yancheng First Hospital Affiliated to Nanjing University Medical School, Yancheng NO. 1 People′s Hospital, Jiangsu Province, Yancheng 224003, China;
2. Department of Hepatobiliary Surgery, Yancheng First Hospital Affiliated to Nanjing University Medical School, Yancheng NO. 1 People′s Hospital, Jiangsu Province,Yancheng 224003, China
Objective To explore the clinical efficacy on downgrading transformation with immune and targeted regimens in initially unresectable advanced hepatocellular carcinoma in a real-world setting. Methods The clinical data of 5 patients with unresectable advanced liver cancer admitted to Yancheng First Hospital Affiliated to Nanjing University Medical School from February 2019 to October 2020 were retrospectively analyzed. Preoperative combined treatment of immune + targeted + local therapy was applied, radical surgery was performed after the tumor reached the transformation standard, and systemic therapy was continued after the surgery to prevent tumor recurrence and metastasis. Results All 5 patients had successful down-stage transformation and were well tolerated by preoperative systemic treatment for 3-9 cycles. The operation time was 261 min (200-320 min), the intraoperative blood loss was 540 ml (200-800 ml),and the intraoperative blood transfusion was 304 ml (0-580 ml). Routine pathology showed varying proportions of residual carcinoma. During the follow-up period of 22.2 weeks (12-31 weeks), there was no tumor recurrence or metastasis,and no perioperative death. Conclusions For patients with unresectable advanced liver cancer, the down-stage transformation strategy of immunotherapy combined with targeted local therapy is worthy of expectation.
Ferlay J，Colombet M，Soerjomataram I，et al.Estimating the global cancer incidence and mortality in 2018： GLOBOCAN sources and methods[J].Int J Cancer，2019，144（8）：1941-1953.
[5]
Zhou MG，Hang HD，Zeng XY，et al.Mortality，morbidity，and risk factors in China and its provinces，1990-2017：a systematic analysis for the Global Burden of Disease Study 2017[J].Lancet，2019，28（394）：1145-1158.
[6]
O′Donnell JS，Hoefsmit EP，Smyth MJ，et al.The promise of neoadjuvant immunotherapy and surgery for cancer treatment[J].Clin Cancer Res，2019，25（19）：5743-5751.
[7]
Xu J，Zhang Y，Jia R，et al.Anti-PD-1 antibody SHR-1210 combined with apatinib for advanced hepatocellular carcinoma，gastric，or esophagogastric junction cancer：an openlabe，dose escalation and expansion study[J].Clin Cancer Res，2019，25（2）：515-523.
[8]
Qin S，Ren Z，Meng Z，et al.Camrelizumab in patients with previously treated advanced hepatocellular carcinoma：a multicentre，open-label，parallel-group，randomised，phase 2 trial[J].Lancet Oncol，2020，21（4）：571-580.
[9]
Kudo M，Finn RS，Qin S，et al.Lenvatinib versus sorafenib in first-line treatment of patients with unresectable hepatocellular carcinoma：A randomised phase 3 non-inferiority trial[J].Lancet，2018，391（10126）：1163-1173．
[10]
Finn RS，Qin S，Ikeda M，et al.Atezolizumab plus bevacizumab in unresectable hepatocellular carcinoma[J].N Engl J Med，2020，382（20）：1894-1905.
Kokudo T，Hasegawa K，Matsuyama Y，et al.Survival benefit of liver resection for hepatocellular carcinoma associated with portalvein invasion[J].J Hepatol，2016，65（5）：938-943.
[14]
Kim DS，Kim BW，Hatano E，et al.Surgical outcomes of hepatocellular carcinoma with bile duct tumor thrombus：a Korea-Japan multicenter study[J].Ann Surg，2020，271（5）：913-921.
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