Efficacy of lenvatinib combined with sintilimab and transcatheter arterial chemoembolization in conversion therapy for unresectable hepatocellular carcinoma

Abstract

Objectives: To compare the efficacy of lenvatinib combined with sintilimab versus transcatheter arterial chemoembolization (TACE) in the conversion therapy for unresectable hepatocellular carcinoma (HCC).

Methodology: A retrospective analysis of the clinical data of 153 patients with unresectable HCC admitted to the Affiliated Hospital of Nanhua University from January 2023 to December 2024 was performed. According to the treatment regimens, the patients were divided into two groups: the study group (n=79) treated with lenvatinib plus sintilimab and the control group (n=74) treated with TACE. The efficacy of conversion therapy, tumor marker levels, tumor morphological features, blood supply, and adverse reactions were compared between the two groups.

Results: Compared with those in the control group, the objective response rate (ORR) (67.09% vs. 47.30%, p=0.013), disease control rate (DCR) (91.14% vs. 79.73%, p=0.044), and conversion resection rate (48.10% vs. 28.38%, p=0.012) in the study group were significantly greater. Similarly, compared with the control group, the study group also exhibited lower levels of alpha-fetoprotein (AFP) (245.76±108.54 ng/mL vs. 186.42±95.37 ng/mL, p<0.0001), protein induced by vitamin K absence or antagonist II (PIVKA-II) (309.25±96.78 ng/mL vs. 245.68±82.35 ng/mL, p<0.0001), and chemokine (C-C motif) ligand 2 (CCL2) (71.76±23.81 ng/mL vs. 58.36±18.42 ng/mL, p<0.0001). Additionally, the blood flow signal intensity of tumor-feeding arteries (t=5.620; p<0.001), reduction rate of maximum tumor diameter (t=3.436; p<0.001), and tumor necrosis rate (t=7.025; p<0.001) were significantly better in the study group than in the control group. There was no significant difference in the incidence of adverse reactions, including hand-foot skin reactions (p=0.474), gastrointestinal reactions (p=0.875), liver function injury (p=0.672), myelosuppression (p=0.539), or fever (p=0.392), between the two groups (P>0.05).

Conclusion: Compared with TACE, lenvatinib combined with sintilimab can improve the therapeutic efficacy of conversion therapy for unresectable HCC, with comparable safety.