FOLFOX–HAIC active in large HCC

Abstract

JCO.21.00608 (2021) More patients receiving FOLFOX– HAIC became eligible for post-treatment surgi cal resection Transarterial chemoembolization (TACE) is the current standardof-care therapy for patients with intermediate-stage hepatocellular carcinomas (HCCs). This approach typically confers a median overall survival (OS) duration of 16–26 months; however, patients with larger HCCs (diameter ≥5 cm) derive considerably less benefit. Now, data from a phase III trial demonstrate the superiority of hepatic arterial infusion chemotherapy (HAIC) with folinic acid, 5-fluorouracil and oxaliplatin (FOLFOX) over TACE in patients with large, unresectable intermediate-stage HCCs. Lead author Shi Ming explains: “In a previous trial, we found that choice of chemotherapy agents has an important role in improving survival outcomes, while embolization does more harm than good for patients with larger tumours”, adding: “we then conducted a phase II trial and the results demonstrated greater response rates with FOLFOX–HAIC than with TACE in this setting”. In this phase III study, a total of 315 patients with unresectable HCCs of Barcelona Clinic Liver Cancer of grades A–B with a largest lesion diameter ≥7 cm were randomly assigned (1:1) to receive either FOLFOX–HAIC or TACE. OS was the primary end point. After a follow-up period of 24 months, patients receiving FOLFOX–HAIC had a median OS duration of 23.1 months versus 16.1 months for those in the TACE group (HR 0.58, 95% CI 0.45–0.75; P < 0.001). Similar improvements in median progression-free survival duration were also observed (9.6 months versus 5.4 months; HR 0.57, 95% CI 0.45–0.72; P < 0.001). More patients receiving FOLFOX–HAIC became eligible for post-treatment surgical resection (23.9% versus 11.5%). Moreover, fewer adverse events were observed g a S t r O i n t e S t i n a l c a n c e r