Make up for the gap at home and abroad! Sun Yat-sen University's new chemotherapy regimen significantly reduces the risk of liver cancer recurrence!

Hepatocellular carcinoma (HCC) accounts for 90% of primary liver cancer cases, and 70% of patients are not eligible
for curative treatment.
At present, surgical resection remains the main choice
of radical treatment option.
However, patients with hepatocellular carcinoma may have recurrence rates of 70% to 80%
after surgical resection.
Although various adjuvant therapies are available to reduce recurrence and prolong OS, there is no global consensus
on adjuvant recommendations for hepatocellular carcinoma after surgical resection.
In addition, the overall outcomes of these interventions are variable, and improving outcomes for these patients is a major challenge
.

This article is the original of Translational Medicine Network, please indicate the source for reprinting

Author: kope

The incidence of microvascular invasion (MVI) in hepatocellular carcinoma is approximately 30% to 50%, and the expected 1- to 60% and 30%-40% disease-free survival (DFS) at 1 and 2 years in MVI-positive patients is approximately 50% to 60% and 30% to 40%, respectively
.
Recently, the Cancer Center of Sun Yat-sen University and the First Affiliated Hospital of Jinan University jointly completed a clinical study
.
This study is the first in the world to confirm that adjuvant FOLFOX hepatic artery perfusion chemotherapy can reduce the risk of postoperative recurrence in people with liver cancer complicated with microvascular invasion, and has good safety, filling the gap
in this field at home and abroad.
The study was published in the Journal of Clinical Oncology
, a leading journal in oncology.

DOI: 10.
1200/JCO.
22.
01142 Journal of Clinical Oncology

Hepatic artery perfusion chemotherapy

 01 

Hepatic arterial perfusion chemotherapy is not a new liver cancer treatment technique, it began
as early as the 70s and 80s of the last century.
At that time, the perfusion
of chemotherapy drugs was mainly performed by surgical hepatic artery catheterization or endovascular interventional techniques.
Compared with systemic chemotherapy, perfusion of chemotherapy drugs in the hepatic arteries can increase the concentration of local drugs in tumor tissues and reduce the distribution of chemotherapy drugs in other organs, resulting in strong antitumor effects and reducing systemic side effects
.

Although some studies have confirmed that hepatic arterial infusion chemotherapy (HAIC) has a higher response rate than systemic chemotherapy, longer OS, and tolerable toxicity, only Japanese guidelines recommend HAIC as a treatment option
for advanced hepatocellular carcinoma.
In addition, comparative studies comparing HAIC with 5-fluorouracil and oxaliplatin (FOLFOX) regimens, alone or in combination with sorafenib, have demonstrated improved outcomes in patients with intermediate and advanced liver cancer
.

Although there is no direct comparison between HAIC and current standard first-line treatments (e.
g.
, a combination of atezolizumab and bevacizumab), given that the overall response rate of atezolizumab and bevacizumab in the IMbrave 150 study was only 27.
3%.

Previous studies have shown significantly better
response rates with HAIC in advanced HCC.
Although it is not possible to directly compare the results of different studies, these data still demonstrate the potential efficacy
of HAIC.
Recently, preliminary findings from this phase III randomized controlled trial in which adjuvant HAIC after hepatectomy may be associated with
a survival benefit in patients with MVI liver cancer.
In this study, efficacy and safety data were updated and followed up for a long time
.

FOLFOX program

 02 

In this multicenter, prospective phase III randomized controlled clinical study that lasted more than 5 years, a total of 315 patients were enrolled in the intention-to-treat population and randomly assigned to treatment and control groups
.
After excluding patients who did not conform to the protocol, a total of 286 patients were enrolled in the treatment and control groups
.
The results showed that the median tumor-free survival in the hepatic artery perfusion chemotherapy group and the control group was 20.
3 months and 10.
0 months, respectively, and the median tumor-free survival in the eligible population was 19.
3 months and 8.
9 months, respectively, which met the primary endpoint
of the study.

In the intention-to-treat population, although the median overall survival rate of the treatment group showed a trend of improvement compared with the control group, no statistical difference was reached, and the reason may be related
to the abundant treatment methods of liver cancer at present, and patients after recurrence can be found in regular review in time and receive effective comprehensive treatment.
In terms of toxic side effects, most of the adverse reactions associated with hepatic arterial perfusion chemotherapy of the FOLFOX regimen were observed to be grade 0-1, only 2 (1.
6%) patients developed grade 3 pain, and no treatment-related deaths
were observed during the study period.

In this study, most patients benefited from DFS
in the first 2 years.
The main reason for the early recurrence of postoperative hepatocellular carcinoma is the presence of small metastases in the residual liver, which is a high-risk outcome
of MVI in liver cancer.
Continuous infusion of FOLFOX drug has the potential to eliminate micrometastases
in the liver parenchyma and blood circulation.
Therefore, HAIC mainly reduces early relapse

The treatment modality is safe and feasible

 03 

Intrahepatic recurrence of hepatocellular carcinoma is more frequent after hepatic resection due to intrahepatic spread or micrometastases of primary cancer cells, and MVI is considered a risk factor
for recurrence.
Given the high risk of recurrence, local adjuvant therapy may have a better survival benefit
than systemic adjuvant therapy in patients with recurrent hepatocellular carcinoma.
Although adjuvant TACE has shown a survival benefit in patients with MVI HCC after radical resection, complications associated with embolization limit its applicability
.

In addition, there is no universally accepted adjuvant therapy
for patients with MVI hepatocellular carcinoma.
The results of the current study confirm that the adjuvant of HAIC versus FOLFOX provides an acceptable survival benefit
.
In addition, studies have shown that FOLFOX-HAIC has an acceptable safety profile and is well
tolerated.

The results of the EACH study confirm the value of systemic chemotherapy in combination with FOLFOX regimens in the treatment of
advanced hepatocellular carcinoma.
Several retrospective studies and some randomized trials have confirmed the survival benefit
of FOLFOX-HAIC alone or in combination with sorafenib in patients with advanced hepatocellular carcinoma with or without MVI.
In conclusion, this study demonstrates that postoperative adjuvant HAIC combined with FOLFOX significantly improves the DFS benefit and acceptable toxicity
in patients with MVI liver cancer.

Resources:

https://ascopubs.
org/doi/full/10.
1200/JCO.
22.
01142?role=tab

Note: This article is intended to introduce the progress of medical research and cannot be used as a reference
for treatment options.
If you need health guidance, please go to a regular hospital
.