Efficacy of radiotherapy combined with immunotherapy plus antiangiogenic therapy for hepatocellular carcinoma
10.3760/cma.j.cn113030-20241109-00429
- VernacularTitle:放疗联合免疫治疗加抗血管生成剂对肝癌的疗效观察
- Author:
Bangping ZHANG
1
;
Yi LE
;
Chenxing HAO
;
Ping JIANG
;
Qingshan YANG
Author Information
1. 锦州医科大学附属第一医院放疗科，锦州 121000
- Publication Type:Journal Article
- Keywords:
Carcinoma, hepatocellular;
Radiotherapy;
Immunotherapy;
Antiangiogenic therapy
- From:
Chinese Journal of Radiation Oncology
2025;34(8):781-789
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the efficacy and safety of radiotherapy combined with sintilimab and bevacizumab (anti-angiogenic agent) in patients with unresectable advanced hepatocellular carcinoma (HCC).Methods:Clinical data of 80 patients with unresectable advanced HCC admitted to Shanghai Mengchao Cancer Hospital from January 2021 to September 2023 were retrospectively analyzed. All patients were divided into two groups based on treatment regimens: the systemic therapy group ( n=41) receiving sintilimab combined with bevacizumab, and combined radiotherapy group ( n=39) receiving radiotherapy plus sintilimab and bevacizumab. Efficacy was evaluated using the response evaluation criteria in solid tumors (RECIST) 1.1 version and modified RECIST for HCC. Treatment-related adverse events (TRAE) were assessed by the common terminology criteria for adverse events (CTCAE) 4.03 version. The primary endpoints were progression-free survival (PFS) and overall survival (OS). Secondary endpoints included objective response rate (ORR), disease control rate (DCR), and TRAE. Independent sample t-test was used for normally distributed quantitative data, and Chi-square test for qualitative data. Survival analysis was performed via Kaplan-Meier method and log-rank test. Univariate and multivariate Cox regression models were applied to analyze prognostic factors. Results:In terms of efficacy, no patient obtained complete response (CR) in the systemic therapy group, while 2 cases achieved CR in the combined radiotherapy group. The ORR was 22% (9/41) in the systemic therapy group and 59% (23/39) in the combined radiotherapy group ( P=0.001). The DCR was 85% (35/41) and 97% (38/39) in the two groups ( P=0.130), with the incidence of progressive disease of 15% (6/41) and 3% (1/39) ( P=0.130), respectively. The median PFS was 8.0 months (95% CI=6.8-9.2 months) in the combined radiotherapy group and 4.4 months (95% CI=4.1-4.7 months) in the systemic therapy group ( P=0.002). The median OS was 19.0 months (95% CI=15.5-22.5 months) in the combined radiotherapy group and 12.5 months (95% CI=9.4-15.6 months) in the systemic therapy group ( P=0.006). Radiotherapy was an independent protective factor for both PFS ( HR=0.474, 95% CI=0.289-0.778, P=0.003) and OS ( HR=0.403, 95% CI=0.218-0.744, P=0.004). The number of tumors >3 was an independent risk factor for both PFS ( HR=2.658, 95% CI=1.485-4.755, P=0.001) and OS ( HR=3.245, 95% CI=1.773-5.939, P=0.001). There was no significant difference in TRAE between two groups ( P > 0.05). Conclusions:Radiotherapy combined with sintilimab and bevacizumab shows high efficacy and acceptable safety in patients with unresectable advanced HCC.
