Work

Liver function dynamics in advanced hepatocellular carcinoma receiving immune checkpoint inhibitors and anti-vascular endothelial growth factor antibody/tyrosine kinase inhibitors with or without transarterial chemoembolization

Year: 2025

Type: article

Abstract: Background: The efficacy and safety of transarterial chemoembolization (TACE) combined with immune checkpoint inhibitors (ICIs) and anti-vascular endothelial growth factor (anti-VEGF) antibody/tyrosine kinase inhibitors (TKIs) have been established. However, it remains unclear whether the addition of TACE to systemic therapies exacerbates liver function deterioration and increases mortality risk. Objectives: To assess liver function changes and their impact on prognosis in patients with advanced hepatocellular carcinoma (HCC) treated with ICIs and anti-VEGF antibody/TKIs with or without TACE as first-line therapy. Design: This is a real-world retrospective cohort study. Methods: Patients with advanced HCC treated with TACE combined with ICIs and anti-VEGF antibody/TKIs (TACE-ICI-VEGF) or ICIs and anti-VEGF antibody/TKIs alone (ICI-VEGF) from January 2018 to June 2024 were retrospectively included. The primary outcomes were changes in albumin-bilirubin (ALBI) score and time to deterioration (TTD) of liver function. The secondary outcomes included overall survival (OS), progression-free survival (PFS), and the relationship between TTD and prognosis. Results: A total of 111 patients were included, with 54 and 57 patients receiving TACE-ICI-VEGF and ICI-VEGF, respectively. Changes in ALBI score were similar between groups (difference in least squares mean, −0.075; 95% confidence interval (CI): −0.298 to 0.148). TTD was also comparable (median for TACE-ICI-VEGF 9.7 months vs. ICI-VEGF 8.5 months; hazard ratio (HR) = 1.19 (95% CI: 0.71–2.01); p = 0.512). TACE-ICI-VEGF group demonstrated a significantly improved median OS (18.3 vs. 11.8 months; HR = 0.60 (95% CI: 0.37–0.98); p = 0.041) and a trend toward prolonged median PFS (14.7 vs. 11.2 months; HR = 0.76 (95% CI: 0.47–1.25); p = 0.278). Patients with liver function deterioration had an increased risk of mortality (median OS: 13.2 vs. 17.0 months; HR = 1.44 (95% CI: 0.88–2.35); p = 0.139). Conclusion: TACE combined with ICIs plus anti-VEGF antibodies/TKIs as first-line treatment generally did not adversely affect liver function. Liver function deterioration was associated with an increased risk of mortality.

Source: Therapeutic Advances in Medical Oncology

DOI: 10.1177/17588359251347363