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Article: Combined Stereotactic Body Radiotherapy and Checkpoint Inhibition in Unresectable Hepatocellular Carcinoma: A Potential Synergistic Treatment Strategy
Title | Combined Stereotactic Body Radiotherapy and Checkpoint Inhibition in Unresectable Hepatocellular Carcinoma: A Potential Synergistic Treatment Strategy |
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Authors | |
Keywords | Stereotactic radiation therapy Stereotactic ablative radiation therapy Checkpoint inhibitor Immunotherapy Hepatocellular carcinoma HCC |
Issue Date | 2019 |
Publisher | Frontiers Research Foundation. The Journal's web site is located at http://www.frontiersin.org/oncology |
Citation | Frontiers in Oncology, 2019, v. 9, article no. 1157 How to Cite? |
Abstract | Background: Current treatments of unresectable hepatocellular carcinoma (HCC) are trans-arterial chemo-embolization (TACE), stereotactic body radiotherapy (SBRT), and targeted therapy. However, these treatments are limited in efficacy and safety for patients with large tumor sizes. Here, we report a case series of combined SBRT and anti-PD-1 therapy in patients with unresectable HCC of large tumors.
Methods: This is a retrospective case series of five patients with unresectable hepatocellular carcinoma who were treated with SBRT followed by anti-PD1 antibodies. Four patients (80%) received a single dose of TACE prior to SBRT. All patients had advanced HCC ineligible of curative intervention. In this study, we report their treatment responses according to modified RECIST (response evaluation criteria in solid tumor) criteria, 1-year local control (LC), progression-free survival (PFS), 1-year overall survival (OS) rate, and toxicities.
Results: Among the five evaluated patients, three patients had underlying diseases of hepatitis B and four patients had Barcelona clinic liver cancer stage C. The median size of their tumors was 9.8 cm (range: 9–16.1 cm). In addition, two patients had tumor vascular thrombosis and one had extra-hepatic disease. Five out of five patients (100%) responded to treatment, with two complete responses (CR) and three partial responses (PR). Among the partial responders, one had a down-staged tumor that became amenable for radiofrequency ablation for tumor clearance. No patient developed tumor progression at the time of analysis during the median follow-up of 14.9 months (range 8.6–19 months). The median PFS was 14.9 months (range: 8.6–19 months); 1-year LC and OS rate were both 100%. One patient had grade ≥ 3 toxicities (pneumonitis and skin reaction). There was no classical radiation-induced liver disease.
Conclusions: The results obtained from these 5 cases demonstrate impressive tumor control from the combination of SBRT and checkpoint inhibitors in patients with large tumors of advanced HCC. Further prospective trials are warranted. |
Persistent Identifier | http://hdl.handle.net/10722/285436 |
ISSN | 2023 Impact Factor: 3.5 2023 SCImago Journal Rankings: 1.066 |
PubMed Central ID | |
ISI Accession Number ID |
DC Field | Value | Language |
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dc.contributor.author | Chiang, CL | - |
dc.contributor.author | Chan, ACY | - |
dc.contributor.author | Chiu, KWH | - |
dc.contributor.author | Kong, FS | - |
dc.date.accessioned | 2020-08-18T03:53:23Z | - |
dc.date.available | 2020-08-18T03:53:23Z | - |
dc.date.issued | 2019 | - |
dc.identifier.citation | Frontiers in Oncology, 2019, v. 9, article no. 1157 | - |
dc.identifier.issn | 2234-943X | - |
dc.identifier.uri | http://hdl.handle.net/10722/285436 | - |
dc.description.abstract | Background: Current treatments of unresectable hepatocellular carcinoma (HCC) are trans-arterial chemo-embolization (TACE), stereotactic body radiotherapy (SBRT), and targeted therapy. However, these treatments are limited in efficacy and safety for patients with large tumor sizes. Here, we report a case series of combined SBRT and anti-PD-1 therapy in patients with unresectable HCC of large tumors. Methods: This is a retrospective case series of five patients with unresectable hepatocellular carcinoma who were treated with SBRT followed by anti-PD1 antibodies. Four patients (80%) received a single dose of TACE prior to SBRT. All patients had advanced HCC ineligible of curative intervention. In this study, we report their treatment responses according to modified RECIST (response evaluation criteria in solid tumor) criteria, 1-year local control (LC), progression-free survival (PFS), 1-year overall survival (OS) rate, and toxicities. Results: Among the five evaluated patients, three patients had underlying diseases of hepatitis B and four patients had Barcelona clinic liver cancer stage C. The median size of their tumors was 9.8 cm (range: 9–16.1 cm). In addition, two patients had tumor vascular thrombosis and one had extra-hepatic disease. Five out of five patients (100%) responded to treatment, with two complete responses (CR) and three partial responses (PR). Among the partial responders, one had a down-staged tumor that became amenable for radiofrequency ablation for tumor clearance. No patient developed tumor progression at the time of analysis during the median follow-up of 14.9 months (range 8.6–19 months). The median PFS was 14.9 months (range: 8.6–19 months); 1-year LC and OS rate were both 100%. One patient had grade ≥ 3 toxicities (pneumonitis and skin reaction). There was no classical radiation-induced liver disease. Conclusions: The results obtained from these 5 cases demonstrate impressive tumor control from the combination of SBRT and checkpoint inhibitors in patients with large tumors of advanced HCC. Further prospective trials are warranted. | - |
dc.language | eng | - |
dc.publisher | Frontiers Research Foundation. The Journal's web site is located at http://www.frontiersin.org/oncology | - |
dc.relation.ispartof | Frontiers in Oncology | - |
dc.rights | This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. | - |
dc.subject | Stereotactic radiation therapy | - |
dc.subject | Stereotactic ablative radiation therapy | - |
dc.subject | Checkpoint inhibitor | - |
dc.subject | Immunotherapy | - |
dc.subject | Hepatocellular carcinoma | - |
dc.subject | HCC | - |
dc.title | Combined Stereotactic Body Radiotherapy and Checkpoint Inhibition in Unresectable Hepatocellular Carcinoma: A Potential Synergistic Treatment Strategy | - |
dc.type | Article | - |
dc.identifier.email | Chiang, CL: chiangcl@hku.hk | - |
dc.identifier.email | Chan, ACY: acchan@hku.hk | - |
dc.identifier.email | Chiu, KWH: kwhchiu@hku.hk | - |
dc.identifier.email | Kong, FS: kong0001@hku.hk | - |
dc.identifier.authority | Chiang, CL=rp02241 | - |
dc.identifier.authority | Chan, ACY=rp00310 | - |
dc.identifier.authority | Chiu, KWH=rp02074 | - |
dc.identifier.authority | Kong, FS=rp02508 | - |
dc.description.nature | published_or_final_version | - |
dc.identifier.doi | 10.3389/fonc.2019.01157 | - |
dc.identifier.pmid | 31799176 | - |
dc.identifier.pmcid | PMC6874138 | - |
dc.identifier.scopus | eid_2-s2.0-85075833802 | - |
dc.identifier.hkuros | 312653 | - |
dc.identifier.hkuros | 320297 | - |
dc.identifier.volume | 9 | - |
dc.identifier.spage | article no. 1157 | - |
dc.identifier.epage | article no. 1157 | - |
dc.identifier.isi | WOS:000499480300001 | - |
dc.publisher.place | Switzerland | - |
dc.identifier.issnl | 2234-943X | - |