在无法切除的肝细胞癌中结合立体定向身体放疗和检查点抑

StephenW

Front Oncol. 2019 Nov 12;9:1157. doi: 10.3389/fonc.2019.01157. eCollection 2019.
Combined Stereotactic Body Radiotherapy and Checkpoint Inhibition in Unresectable Hepatocellular Carcinoma: A Potential Synergistic Treatment Strategy.
Chiang CL1, Chan ACY2, Chiu KWH3, Kong FS1,4.
Author information

1
    Department of Clinical Oncology, University of Hong Kong, Hong Kong, Hong Kong.
2
    Department of Surgery, University of Hong Kong, Hong Kong, Hong Kong.
3
    Department of Diagnostic Radiology, University of Hong Kong, Hong Kong, Hong Kong.
4
    Department of Radiation Oncology, University Hospitals Cleveland Medical Center, Case Western Reserve University Medical School, Case Comprehensive Cancer Center, Cleveland, OH, United States.

Abstract

Background: Current treatments of unresectable hepatocellular carcinoma (HCC) are trans-arterial chemo-embolization (TACE), stereotactic body radiotherapy (SBRT), and targeted therapy. However, these treatments are limited in efficacy and safety for patients with large tumor sizes. Here, we report a case series of combined SBRT and anti-PD-1 therapy in patients with unresectable HCC of large tumors. Methods: This is a retrospective case series of five patients with unresectable hepatocellular carcinoma who were treated with SBRT followed by anti-PD1 antibodies. Four patients (80%) received a single dose of TACE prior to SBRT. All patients had advanced HCC ineligible of curative intervention. In this study, we report their treatment responses according to modified RECIST (response evaluation criteria in solid tumor) criteria, 1-year local control (LC), progression-free survival (PFS), 1-year overall survival (OS) rate, and toxicities. Results: Among the five evaluated patients, three patients had underlying diseases of hepatitis B and four patients had Barcelona clinic liver cancer stage C. The median size of their tumors was 9.8 cm (range: 9-16.1 cm). In addition, two patients had tumor vascular thrombosis and one had extra-hepatic disease. Five out of five patients (100%) responded to treatment, with two complete responses (CR) and three partial responses (PR). Among the partial responders, one had a down-staged tumor that became amenable for radiofrequency ablation for tumor clearance. No patient developed tumor progression at the time of analysis during the median follow-up of 14.9 months (range 8.6-19 months). The median PFS was 14.9 months (range: 8.6-19 months); 1-year LC and OS rate were both 100%. One patient had grade ≥ 3 toxicities (pneumonitis and skin reaction). There was no classical radiation-induced liver disease. Conclusions: The results obtained from these 5 cases demonstrate impressive tumor control from the combination of SBRT and checkpoint inhibitors in patients with large tumors of advanced HCC. Further prospective trials are warranted.

Copyright © 2019 Chiang, Chan, Chiu and Kong.
KEYWORDS:

HCC; checkpoint inhibitor; hepatocellular carcinoma; immunotherapy; stereotactic ablative radiation therapy; stereotactic radiation therapy

PMID:
    31799176
PMCID:
    PMC6874138
DOI:
    10.3389/fonc.2019.01157

StephenW

前Oncol。 2019十一月12; 9：1157。 doi：10.3389 / fonc.2019.01157。 eCollection 2019。
在无法切除的肝细胞癌中结合立体定向身体放疗和检查点抑制：潜在的协同治疗策略。
Chiang CL1，Chan ACY2，Chiu KWH3，Kong FS1,4。
作者信息

1个
    香港大学临床肿瘤学系，香港，香港。
2
    香港大学外科系，香港，香港。
3
    香港大学诊断放射学系，香港，香港。
4
    美国俄亥俄州西克里夫兰市凯斯西储大学医学院克利夫兰医学中心大学医院放射肿瘤学系。

抽象

背景：不可切除的肝细胞癌（HCC）的当前治疗方法是经动脉化学栓塞（TACE），立体定向放疗（SBRT）和靶向治疗。但是，这些疗法对大肿瘤患者的疗效和安全性受到限制。在这里，我们报告了SBRT和抗PD-1治疗联合治疗无法切除的大肿瘤HCC患者的一系列病例。方法：这是一个回顾性病例系列，对5例不可切除的肝细胞癌患者进行了SBRT和抗PD1抗体治疗。四名患者（80％）在SBRT前接受了单剂TACE。所有患者均患有晚期肝癌，不符合治愈干预的条件。在这项研究中，我们根据改良的RECIST（实体瘤反应评估标准）标准，1年局部对照（LC），无进展生存期（PFS），1年总生存期（OS）率报告了他们的治疗反应，和毒性。结果：在五名接受评估的患者中，三名患有乙型肝炎基础疾病，四名患有巴塞罗那临床肝癌C期。他们的肿瘤中位大小为9.8厘米（范围：9-16.1厘米）。另外，两名患者患有肿瘤血管血栓形成，另一名患有肝外疾病。五分之五的患者（100％）对治疗有反应，其中两个完全缓解（CR）和三个部分缓解（PR）。在部分反应者中，一名患有晚期肿瘤的患者可通过射频消融术清除肿瘤。在中位随访14.9个月（8.6-19个月）期间，分析时没有患者出现肿瘤进展。 PFS中位数为14.9个月（范围：8.6-19个月）； 1年LC和OS率均为100％。一名患者的毒性≥3级（肺炎和皮肤反应）。没有经典的辐射诱发的肝病。结论：从这5例病例中获得的结果表明，SBRT和检查点抑制剂联合治疗晚期HCC大肿瘤的患者可实现令人印象深刻的肿瘤控制。有必要进行进一步的前瞻性试验。

版权所有©2019 Chiang，Chan，Chiu和Kong。
关键字：

HCC；检查点抑制剂；肝细胞癌；免疫疗法立体定向消融放射治疗；立体定向放射治疗

PMID：
    31799176
PMCID：
    PMC6874138
DOI：
    10.3389 / fonc.2019.01157