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Al B. Benson III, MD, FACP, FASCO

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Triplet Combination Therapy Under Study in High-Risk Advanced Liver Cancer

By: Joshua D. Madera, MS
Posted: Tuesday, January 17, 2023

Treatment with oxaliplatin, leucovorin, and fluorouracil (FOLFOX) in conjunction with hepatic arterial infusion chemotherapy (HAIC), the kinase inhibitor lenvatinib, and the PD-1 monoclonal antibody toripalimab may prove to be a safe therapeutic option for patients with hepatocellular carcinoma given its antitumor activity, according to a phase II study published in the European Journal of Cancer. The extent of this combination therapy’s efficacy may be dependent on the patient’s levels of C-C motif chemokine ligand 28 (CCL28) and betacellulin (BTC), explained Ming Shi, MD, PhD, of Sun Yat-sen University, Guangzhou, China, and colleagues. These levels may subsequently serve as potential biomarkers for which patients will be responsive to such triplet therapy, although a confirmatory phase III trial is necessary.

A total of 36 patients with advanced hepatocellular carcinoma were enrolled in the study. All patients had either vascular invasion or extrahepatic disease metastasis and received no previous treatment. Patients were treated with 21-day cycles of FOLFOX-HAIC, toripalimab, and lenvatinib.

There was an overall progression-free survival rate of 80.6% at the 6-month interval, with a median progression-free survival of 10.4 months at the final analysis. In addition, the overall survival rate was 17.9 months with extended patient follow-up. Overall response rates of 63.9% and 66.7% were identified using Response Evaluation Criteria in Solid Tumors (RECIST) and modified RECIST, respectively. Moreover, there was a 14.4-month median duration of response for patients. Although there were no treatment-related deaths, patients commonly experienced hypertension, elevated aspartate aminotransferase levels, and thrombocytopenia. Furthermore, an “unsatisfactory prognosis” was observed in patients who had low levels of CCL28 and BTC.

Disclosure: The study authors reported no conflicts of interest.


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