Prognostic Value of Alpha-Fetoprotein in Unresectable Hepatocellular Carcinoma Treated with Hepatic Artery Infusion Chemotherapy Combined with Lenvatinib and Camrelizumab

Abstract

Purpose

This study aimed to assess the prognostic significance of alpha-fetoprotein (AFP) response in patients with unresectable hepatocellular carcinoma (u-HCC) who underwent hepatic artery infusion chemotherapy (HAIC) combined with lenvatinib and camrelizumab.

Methods

A retrospective review was conducted on patients with u-HCC receiving treatment with HAIC combined with lenvatinib and camrelizumab. Early AFP response was defined as a >20% decrease in AFP within 4 weeks, and AFP response as a >75% decrease in AFP within 8 weeks. The correlation between early AFP response, AFP response, therapeutic response, overall survival (OS), and progression-free survival (PFS) was investigated.

Results

The study included 63 patients. AFP responders exhibited superior objective response rates compared to AFP non-responders, as determined by RECIST v1.1 or mRECIST criteria (45.5 vs. 18.2%, p=0.014, or 81.8 vs. 48.5%, p=0.013). Furthermore, early AFP responders demonstrated prolonged OS (not reached vs. 8.0 months, p<0.001) and PFS (13.3 vs. 3.0 months, p= 0.018) relative to early AFP non-responders. Similarly, AFP responders exhibited improved OS (not reached vs. 9.0 months, p<0.001) and PFS (19.3 vs. 5.1 months, p=0.002) compared to AFP non-responders. Multivariate analysis results indicated that both early AFP response and AFP response independently predicted OS [hazard ratio (HR) 2.963, 95% confidence interval (CI) 1.333–6.585, p=0.008, and HR 6.182, 95% CI 1.780–21.466, p=0.004] and PFS (HR 2.186, 95% CI 1.107–4.318, p=0.024, and HR 3.078, 95% CI 1.407–6.730, p=0.005), serving as significant prognostic values.

Conclusion

Early AFP response and AFP response serve as predictive biomarkers for the effectiveness of HAIC combined with lenvatinib and camrelizumab in patients with u-HCC.

Keywords:

• unresectable hepatocellular carcinoma
• alpha-fetoprotein
• hepatic arterial infusion chemotherapy
• lenvatinib
• camrelizumab

Abbreviations

AFP, alpha-fetoprotein; BCLC, Barcelona Clinic Liver Cancer; CI, confidence interval; CR, complete response; DCR, disease control rate; HAIC, hepatic arterial infusion chemotherapy; HCC, Hepatocellular carcinoma; HR, hazard ratio; HVTT, hepatic vein tumor thrombus; ORR, objective response rate; OS, overall survival; PD, progressive disease; PFS, progression-free survival; PR, partial response; PVTT, portal vein tumor thrombosis; SD, stable disease; u-HCC, unresectable hepatocellular carcinoma; VEGF, vascular endothelial growth factor.

Data Sharing Statement

The data that support the results of this study are obtainable upon request from the corresponding author.

Ethics Statement

The Ethics Committee of the First Affiliated Hospital, Jiangxi Medical College, Nanchang University reviewed and granted approval for this study (Approval No. (2022) CDYFYYLK (06-009)).

Patient Consent for Publication

Informed consent was exempted due to the retrospective nature of the study, and the absence of patient-identifiable information.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

There is no funding to report.