Real-world outcomes of stereotactic body radiotherapy plus sintilimab and bevacizumab for hepatocellular carcinoma with portal vein tumor thrombus

TL;DR

Combining stereotactic body radiotherapy with sintilimab and bevacizumab improves survival and response rates in liver cancer patients with vein tumor blockage.

Contribution

Demonstrates that adding radiotherapy to existing treatment improves outcomes for hepatocellular carcinoma with portal vein tumor thrombus.

Findings

SBRT + Sin + Bev significantly increased median overall survival to 18.9 months compared to 9.3 months with Sin + Bev alone.

The combination therapy also improved progression-free survival and objective response rates.

Treatment-related adverse events were manageable and acceptable with the combined therapy.

Abstract

Sintilimab plus bevacizumab (Sin + Bev) is recommended as a first-line treatment for hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT); however, its efficacy remains limited. This study aimed to assess the efficacy and safety of stereotactic body radiotherapy (SBRT) combined with Sin + Bev for HCC with PVTT.

This retrospective study included 69 HCC patients with PVTT treated at two centers in China from August 2021 to December 2022. Patients received either SBRT + Sin + Bev (n = 31) or Sin + Bev alone (n = 38). Primary endpoints were overall survival (OS) and progression-free survival (PFS). Secondary endpoints included objective response rate (ORR) and treatment-related adverse events (TRAEs).

Baseline characteristics showed similar distributions between the two groups. SBRT + Sin + Bev group showed a significant increase in both median OS (18.9 vs 9.3 months, P < .001), median PFS (9.1 vs 4.7 months, P = .0015), and ORR (64.6% vs 26.3%, P = .031) compared to Sin + Bev group. TRAEs in SBRT + Sin + Bev group were mostly manageable and acceptable compared to Sin + Bev group. Multivariate analysis confirmed that SBRT + Sin + Bev was an independent prognostic factor for better OS (P < .001) and better PFS (P < .001).

SBRT combined with sintilimab plus bevacizumab appears to improve treatment efficacy and demonstrates a favorable safety and feasibility profile for HCC with PVTT.

Figures