# Hepatic arterial infusion chemotherapy combined with apatinib plus camrelizumab for advanced hepatocellular carcinoma with type Vp4 portal vein tumor thrombosis: a multicenter propensity score-matching analysis

## TL;DR

A combination of HAIC, apatinib, and camrelizumab improves survival and reduces tumor progression in advanced liver cancer with severe portal vein tumor thrombosis.

## Contribution

A novel combination therapy for advanced hepatocellular carcinoma with Vp4 portal vein tumor thrombosis is shown to improve survival and tumor response.

## Key findings

- Median overall survival was 24.1 months with combination therapy versus 7.2 months with HAIC alone.
- Combination therapy improved objective response rates for intrahepatic lesions and portal vein tumor thrombosis.
- Adverse events were manageable with no grade 5 toxicities observed in the combination therapy group.

## Abstract

Portal vein main trunk invasion is a serious and difficult complication of hepatocellular carcinoma (HCC), with extremely poor prognosis and limited treatment options. The traditional standard sorafenib has a limited efficacy. The combination of hepatic arterial infusion chemotherapy (HAIC) with camrelizumab and apatinib has shown satisfactory efficacy in previously advanced HCC. Therefore, this approach has potential advantageous survival benefits for HCC with invasion of the portal vein main trunk.

A retrospective review was conducted on the clinical data of advanced HCC patients with type Vp4 portal vein invasion who received HAIC combined with apatinib and camrelizumab (HAICAC group) or HAIC alone (HAIC group) treatment in four medical centers from June 2016 to December 2023. Propensity score matching was employed to balance the baseline differences between the groups. The overall survival, progression-free survival, objective response rate and disease control rate were compared between the groups.

Following PSM, the HAICAC regimen demonstrated significantly superior clinical outcomes, with median OS (24.1 versus 7.2 months) and PFS (7.0 versus 4.3 months) significantly exceeding those of HAIC monotherapy (all P<0.001). The combination therapy also exhibited markedly improved tumor response rates, achieving superior objective response rates for both intrahepatic lesions (75.6% versus 31.4%, P<0.001) and PVTT (60.5% versus 17.4%, P<0.001). While the HAICAC group showed a higher incidence of immune-related adverse events compared to the HAIC group, all events were manageable and no grade 5 toxicities occurred.

For HCC with Vp4 type PVTT, the combination regimen of HAIC plus apatinib and camrelizumab demonstrates promising efficacy in reducing both intrahepatic tumor burden and thrombus progression, representing a potentially viable treatment approach with an acceptable safety profile.