Effectiveness and Safety of TRIPLET Protocol in Patients with Intermediate-Stage Hepatocellular Carcinoma to
1Department of Interventional Radiology and Vascular Surgery, The First Affiliated Hospital of Jinan University, Avenue., Guangzhou 510630, PR China (Y.Z., C.L.).
Rationale And Objective:
The treatment scheme in hepatocellular carcinoma (HCC) refractory to transarterial chemoembolization (TACE) is still controversial.
Objective:
To compare the efficacy and safety of hepatic arterial infusion chemotherapy (HAIC) combined with apatinib plus camrelizumab (TRIPLET protocol) versus HAIC alone for HCC refractory to TACE.
Materials And Methods:
From April 2019 to September 2024, a total of 275 patients with intermediate-stage HCC refractory to TACE based on modified Response Evaluation Criteria in Solid Tumors criteria by two radiologists were reviewed, classifying into the HAIC group (n = 117) and TRIPLET group (n = 158). Propensity score matching (PSM) method was used to reduce the selective bias. The overall survival (OS) and post progression-free survival (PPS) were compared using the Kaplan-Meier method with log-rank test. Multivariable analyses of independent prognostic factors were evaluated by means of the forward stepwise Cox regression model.
Results:
After PSM 1:1, the median OS was 11.5 months in TRIPLET group was longer significantly than that (median OS was 7.8 months) in HAIC group (P < 0.001). The median PPS was 8.6 months in TRIPLET group was longer significantly than that (4.8 months) in the HAIC group (P < 0.001). Multivariate analyses showed that the factors that significantly affected the OS were α-fetoprotein (hazard ratio [HR]: 2.14; 95% confidence interval [CI]:1.26-3.98; P = 0.006), and HAIC treatment (HR: 1.92; 95% CI: 1.16-3.33; P = 0.012). Multivariate analyses showed that the factors that significantly affected the PPS were albumin-bilirubin grade 2 (HR:1.63; 95% CI: 1.03-2.60; P = 0.037), tumor diameter > 5 cm (HR: 1.67; 95% CI: 1.34-2.09; P < 0.001) and HAIC treatment (HR: 1.67; 95% CI: 1.08-2.63; P = 0.025) significantly affected the PPS.
Conclusion:
This TRIPLET protocol has significant safety and effectiveness in the management of patients with HCC refractory to TACE.
Design:
A retrospective, multi-institutional study.
