Combined Iodine-125 Seed Strand, Transarterial Chemoembolizaiton, Lenvatinib and Anti-PD-1 Antibodies Therapy for Unresectable Hepatocellular Carcinoma and Vp4 Portal Vein Tumor Thrombus: A Real-world Study

Abstract Purpose To evaluate the safety and efficacy of interventional therapy (iodine-125 seed strand [with or without stent] implantation plus transarterial chemoembolization) combined with systemic therapy (lenvatinib plus anti-PD-1 antibody) as first-line treatment for hepatocellular carcinoma (HCC) patients with Vp4 portal vein tumor thrombus (PVTT). Methods From December 2018 to June 2021, 75 patients with HCC and Vp4 PVTT were included in this single-center retrospective study. Forty-one patients underwent interventional therapy combined with lenvatinib and anti-PD-1 antibody (group A; n = 41), while 34 cases underwent interventional therapy combined with lenvatinib (group B; n = 34). Stent occlusion rates and overall response rates (ORRs) for intrahepatic tumors and PVTT were compared. Median overall survival (mOS) and median progression-free survival (mPFS) were compared by using Kaplan-Meier method. Results The technique was performed successfully in all patients. ORRs for intrahepatic tumors (58.5% vs 11.8%, p < .001) and PVTT (76.9% vs 33.3%, p < .001) were significantly higher in group A compared with group B. Stent occlusion rates were 17.8% and 39.3% in groups A and B, respectively (p = .076). The mOS and mPFS were significantly longer in group A compared with group B (mOS, 17.7 ± 1.7 vs 11.2 ± 0.9 months, p = .003; mPFS, 16.8 ± 1.6 vs 7.0 ± 1.0 months, p < .001). Multivariate analysis found that treatment regimen and sex were two independent prognostic factors of OS. Conclusions Interventional therapy (iodine-125 seed strand [with or without stent] implantation plus transarterial chemoembolization) combined with systemic therapy (lenvatinib plus anti-PD-1 antibody) is safe and effective as first-line treatment for HCC patients with Vp4 PVTT.