Efficacy of additional locoregional therapy based on systemic therapy after intrahepatic progression for BCLC stage B/C hepatocellular carcinoma: A real-world study

Background: The leading course of death in patients with advanced hepatocellular carcinoma (HCC) is intrahepatic progression and associated hepatic failure. The study aimed to evaluate the efficacy of locoregional therapy targeting intrahepatic lesions after intrahepatic progression for advanced HCC.

Methods: Consecutive 263 HCC patients who received lenvatinib combined with immunotherapy were reviewed. Until to last follow-up, 178 patients had disease progression:107 patients had intrahepatic progression (IP group) with or without extrahepatic progression, and 71 patients only had extrahepatic progression (EP group). After intrahepatic progression, 47 patients received systemic therapy (Systemic group), 23 patients received locoregional-systemic therapy (Loco-systemic group), and 37 patients received best supportive therapy (Supportive group).

Results: The EP group showed significantly longer OS (overall survival) than the IP group (not reached vs 16.2 months, P = 0.009). Median OS was significantly longer in the Loco-systemic group (20.3 v 8.8 months; P = 0.03) than in the Systemic group. The median PFS (progression-free survival) was 11.7 months in the Loco-systemic group and 5.3 months in the Systemic group (P = 0.046). In patients who progressed fast in first-line treatment, there was no significant difference in OS and PFS between the two groups.

Conclusion: Intrahepatic progression was associated with a poorer survival outcome compared with extrahepatic progression in advanced HCC. After intrahepatic progression, additional locoregional therapy based on systemic therapy may offer clinical benefits on OS and PFS in second-line treatment, the benefits were limited to patients who had once achieved tumor control during their first-line treatments.