The efficacy and safety of adding hepatic arterial infusion chemotherapy using cisplatin to lenvatinib for advanced hepatocellular carcinoma

Combination therapy with lenvatinib and hepatic arterial infusion chemotherapy (HAIC) using cisplatin had a high antitumor effect for advanced hepatocellular carcinoma (HCC); however, the efficacy of adding HAIC using cisplatin to lenvatinib remains unclear. We retrospectively reviewed the charts of advanced HCC patients who were treated with lenvatinib or lenvatinib plus HAIC using cisplatin and compared the efficacy between them. The patients received 12 mg or 8 mg of lenvatinib once daily by weight in both groups, and 65 mg/m2 of cisplatin through the hepatic artery every 4 weeks in the lenvatinib plus HAIC group. A total of 140 patients were included in this analysis, with 40 patients in each of the lenvatinib group and lenvatinib plus HAIC groups selected through propensity score matching analysis. Objective response rate (20.0 vs. 67.5%, p < 0.001), progression-free survival (median 4.6 vs. 9.2 months, p = 0.032), and overall survival (median 12.1 vs. 20.6 months, p = 0.024) for the lenvatinib plus HAIC group were significantly better compared with those for the lenvatinib group. Subgroup analysis suggested a greater prognostic benefit in patients with larger tumor size, vascular invasion, and those with prior treatment with immune checkpoint inhibitors. Although the main grade 3-4 adverse events more frequently observed in the lenvatinib plus HAIC group were hematological toxicities, all were manageable. Adding HAIC using cisplatin to lenvatinib improved the response to treatment and outcome for advanced HCC patients. Further studies are needed to confirm these results and explore the clinical positioning of lenvatinib plus HAIC.