Efficacy and safety of drug-eluting bead transarterial chemoembolization combined with hepatic arterial infusion chemotherapy in unresectable gastric cancer with liver metastasis.

Abstract

e16006 Background: Gastric cancer is the fifth most common cancer and the fourth leading cause of cancer-related mortality worldwide. The liver is the primary metastatic site. Despite advances in diagnosis and treatment, the prognosis of gastric cancer with liver metastasis (GCLM) remains poor. While transarterial chemoembolization (TACE) and hepatic arterial infusion chemotherapy (HAIC) are widely used for liver cancer, their role in GCLM remains underexplored. In this study, we evaluated the effecacy and safety of DEB-TACE combined with HAIC in unresectable GCLM. Methods: 62 patients diagnosed with gastric cancer with liver metastasis (GCLM) and treated at Peking University Cancer Hospital between July 2018 and June 2023 were enrolled in this restrospective study. Patients underwent 153 treatments using two different types of drug-eluting beads, either HepaSphere or drug-coated beads (DCB). Among them, 33 received HepaSphere DEB-TACE with HAIC-FOLFOX (Hepa-HAIC), and 29 received DCB DEB-TACE with HAIC-FOLFOX (DCB-HAIC). The primary endpoints were hepatic progression-free survival (mhPFS), progression-free survival (mPFS), and overall survival (mOS). Secondary endpoints included objective response rate (ORR), disease control rate (DCR), and safety. Results: Among the patients (53 male, 9 female), 75.8% had intestinal-type cancer. Over 95% underwent prior treatments. HER2-negative and PD-L1-negative were present in 79% and 71% of patients, respectively, and 96.8% were microsatellite-stable (MSS). In the Hepa-HAIC cohort, both (mhPFS) and (mPFS) were longer compared to the DCB-HAIC cohort (mhPFS: 8.6 months vs. 7.6 months; mPFS: 5.7 months vs. 4.4 months), although these differences did not reach statistical significance. The mOS was identical, at 10.7 months. ORR and DCR were similar across groups (Hepa-HAIC: 30.3%/75.8%; DCB-HAIC: 31.0%/75.9%). Propensity score matching (PSM) analysis were consistent with these findings. There were no treatment-related deaths. The most common serious adverse events (AEs) were transaminase elevation and pain. Most AEs were comparable between these two groups. However, nausea, vomiting, and severe pain were significantly less frequent in the Hepa-HAIC group compared to the DCB-HAIC group (nausea: 5.6% vs. 31.7%, p = 0.001; vomiting: 4.2% vs. 31.7%, p < 0.001; severe pain: 8.3% vs. 22.2%, p = 0.01). Conclusions: The combination of DEB-TACE and HAIC demonstrates promising efficacy and tolerability, particularly with HepaSphere, making it a viable treatment option for unresectable GCLM.