Early Tumor Marker Response Predicts Treatment Outcomes in Patients with Unresectable Hepatocellular Carcinoma Receiving Combined Lenvatinib, Immune Checkpoint Inhibitors, and Transcatheter Arterial Chemoembolization Therapy

Abstract

Meng-Chao Luo,1,2,* Jia-Yi Wu,1,3,* Jun-Yi Wu,1,3 Zhong-Tai Lin,1,2 Yi-Nan Li,3 Zhen-Xin Zeng,3 Shao-Ming Wei,1,2 Mao-Lin Yan1,3 1Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian Province, 350001, People’s Republic of China; 2Department of General Surgery, Fujian Provincial Hospital, Fuzhou, Fujian Province, 350001, People’s Republic of China; 3Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, Fujian Province, 350001, People’s Republic of China*These authors contributed equally to this workCorrespondence: Mao-Lin Yan, The Shengli Clinical Medical College of Fujian Medical University, Dongjie Road 134, Fuzhou, Fujian Province, 350001, People’s Republic of China, Tel [phone], Fax [phone], Email [email protected] Shao-Ming Wei, Department of General Surgery, Fujian Provincial Hospital, Jinrong South Road 516, Fuzhou, Fujian Province, 350001, People’s Republic of China, Tel [phone], Fax [phone], Email [email protected]: Few reliable biomarkers for predicting the efficacy of triple therapy (lenvatinib + immune checkpoint inhibitors + transarterial chemoembolization) exist for patients with unresectable hepatocellular carcinoma (uHCC). This study explored the prognostic role of alpha-fetoprotein (AFP) and des-gamma-carboxyprothrombin (DCP) levels in patients with uHCC receiving triple therapy.Patients and Methods: This retrospective study included 93 patients with uHCC who received triple therapy at Fujian Provincial Hospital between August 2020 and November 2022. Depending on the respective baseline levels, the patients were divided into high-AFP and high-DCP groups. An early response was defined as an AFP or DCP concentration > 50% less than the baseline concentration after 6 weeks of triple therapy. The primary endpoint was the objective response rate (ORR). The secondary endpoints were progression-free survival (PFS) and overall survival (OS).Results: After 6 weeks of triple therapy, 75.3% (58/77) and 78.9% (60/76) of patients in the high-AFP and high-DCP groups achieved an objective response. Early AFP and DCP responses were positively associated with ORR (high-AFP group: odds ratio [OR]: 13.542; 95% confidence interval [CI]: 3.991– 45.950, p 50% predicts better treatment outcomes in uHCC patients.Keywords: unresectable hepatocellular carcinoma, alpha-fetoprotein, des-gamma-carboxyprothrombin, combination therapy, tumor response

Keywords

• unresectable hepatocellular carcinoma
• alpha-fetoprotein
• des-gamma-carboxyprothrombin
• combination therapy
• tumor response