ABSTRACT
Objective:To study the safety and treatment outcomes of portal vein embolization (PVE) combined with lenvatinib plus an anti-programmed death-1(PD-1) antibody to treat patients with initially unreasectable hepatocellular carcinoma (uHCC).Methods:This study retrospectively analyzed the data of six patients with uHCC who received first-line combined systemic therapy with lenvatinib plus an anti-PD-1 antibody, and then underwent pre-hepatectomy PVE at the Department of Liver Surgery at Zhongshan Hospital, Fudan University from May 2019 to November 2020. All enrolled patients were males, aged (54.6±6.2) (ranged 46 to 63) years. Tumor response and liver volume were evaluated by medical imagings once every 2 months (±2 weeks) and evaluated using the Response Evaluation Criteria in Solid Tumours (version 1.1). Patients were followed-up by outpatient interviews or by phone calls to record their survival and tumor outcome status.Results:Three of the six enrolled patients had Barcelona Clinic Liver Cancer stage A and three had stage B disease. One patient achieved a partial response and five patients had stable diseases. The mean ± s. d. future liver remnant (FLR) percentage was (29.0±8.9) % before PVE and the combination therapy, and was (41.3±10.8) % before the last evaluation for liver surgery ( t=10.79, P<0.001). Hepatectomy was carried out in five patients, and one patient who failed to develop significant FLR hypertrophy did not undergo hepatectomy. Grade B post-hepatectomy liver failure and major postoperative complications (i.e. pleural effusion requiring additional percutaneous drainage) occurred in one patient. After a median post-operative follow-up of 4.5 (range: 1.0-12.3) months, all five patients were alive and were tumor free. Conclusion:PVE followed by hepatectomy is feasible in a uHCC patients receiving systemic therapy with lenvatinib and an anti-PD-1 antibody.
ABSTRACT
Biliary tract cancer is characterized by high heterogeneous, rare and refractory malignancy. Since patients are often diagnosed at late stage, the radical resection rate is low, and the effect of traditional adjuvant therapy is limited, therefore the prognosis of patients is poor. Recently Immunotherapy has opened up a new field for tumor therapy. Porgrammed death-1 (PD-1) antibody therapy has a great clinical application prospects. The efficacy of related therapies in biliary tract tumors is being evaluated under a number of clinical trials. One of the main challenges is to identify the biomarkers that can predict the response and prognosis of PD-1 antibody therapy. This article aims to summarize the research progress of PD-1 antibody therapy and related biomarkers such as PD-L1, tumor mutational burden, DNA damage repair in biliary tract cancers, and to prospect the future research direction.