TACE Plus Camrelizumab for Treating Advanced, Recurrent, Unresectable HCC

By Fatema Tashrifwala, MD - Last Updated: March 19, 2025

Fatema Tashrifwala, MD, Stamford Health, highlights her recent publication in Cureus on TACE plus camrelizumab for patients with advanced, recurrent, and unresectable hepatocellular carcinoma. Dr. Tashrifwala also explains why researchers chose to investigate camrelizumab and details what information is still needed to confirm the efficacy of TACE plus camrelizumab.

Can you explain the previous research related to combining first-line TACE with immunotherapy for intermediate-stage HCC? Why is this treatment strategy being further explored?

Dr. Tashrifwala: Currently, the first-line treatment for hepatocellular carcinoma is transarterial chemoembolization (TACE). However, in recent years, a novel concept has emerged that involves combining TACE with immune checkpoint inhibitors. This approach has gained attention over the past decade, introducing a relatively new strategy in the field.

One notable immune checkpoint inhibitor studied is atezolizumab, though there are several others such as durvalumab, which is also under discussion in ongoing research. When these inhibitors are used in conjunction with TACE, a synergistic effect is observed. This combination demonstrates significant antitumor activity, providing a durable response that contributes to long-term survival of over two years, surpassing the outcomes achieved with TACE alone.

The efficacy and safety of this combined treatment approach have been closely examined, revealing promising results and supporting its potential as a valuable therapeutic option for hepatocellular carcinoma.

Describe the design and methodology of your analysis. Why was camrelizumab chosen as the therapy to investigate?

Dr. Tashrifwala: The methodology of our study adhered to the PRISMA 2020 guidelines, encompassing a systematic review and meta-analysis. We conducted a search across PubMed, Google Scholar, and Cochrane Central Registries to identify randomized controlled trials focusing on liver ATC (anaplastic thyroid carcinoma), new checkpoint inhibitors, and specifically, camrelizumab. The paper includes a detailed account of our search strategy.

Our initial search yielded approximately 1,023 records. Subsequently, duplicates were removed, as some records were duplicated across multiple platforms. Exclusions were made based on relevance to our topic or interest, resulting in the shortlisting of six articles for inclusion in our study. A meta-analysis was conducted on these selected articles, and a quality assessment of the included studies was also provided.

The selection of camrelizumab was motivated by the absence of studies targeting this particular drug. Previous research predominantly focused on drugs such as cipronatin, lapatinib, and tocilizumab. While these drugs have been extensively studied, camrelizumab has not received comparable attention. Our research revealed a notably lower frequency of serious adverse effects (SAEs) associated with camrelizumab. The most common side effects observed were rash (27.1% of patients), hypertension (18.6%), fatigue (17.1%), diarrhea (17.1%), paresthesia (15.7%), and nausea (15.7%). These side effects, if present, appeared to be milder compared to those associated with other drugs studied previously.

What types of studies were considered in your analysis, and what trial end points were included in your final determinations of “effectiveness?”

Dr. Tashrifwala: Our study exclusively incorporated randomized controlled trials, involving a total of 288 patients from six selected studies. The focus of our analysis included evaluating the complete response rate, indicating the absence of tumors, and the partial response rate, reflecting a positive response to therapy. Additionally, we examined the percentage of patients with stable disease, the objective response rate, and the progression-free survival.

In our study, the progression-free survival was determined to be 6.2 months, meaning no tumor progression for this duration. Specifically, the complete response rate in our study was 7.35%, while a partial response was observed in 37.1% of patients.

What were your overall findings of TACE plus camrelizumab, both in terms of effectiveness and toxicity?

Dr. Tashrifwala: Among the 288 patients in our study, we observed a complete response rate of 7.35%, with a partial response rate noted in 37.1% of patients. Stable disease was identified in 28.7% of patients, and the objective response rate was determined to be 46.13%. The disease control rate reached 77.1%, and the progression-free survival remained at 6.2 months, as previously mentioned.

In summary, our findings strongly indicate that camrelizumab, when combined with TACE for the treatment of hepatocellular carcinoma, is an effective therapeutic option with minimal toxicity. Although our study did not specifically investigate toxicity, we referenced other studies on immune checkpoint inhibitors to provide context. Comparing our results to previous studies on sorafenib and lapatinib, camrelizumab exhibited a significantly lower risk of serious adverse effects.

What further information or studies are research is needed to confirm the benefit of this combination in patients with HCC?

Dr. Tashrifwala: We also recognize the importance of adopting an individualized treatment approach, considering various factors such as tumor staging, markers, and patient characteristics. Over the past decade, a key conclusion has emerged: TACE alone may not be as effective for tumors exceeding five centimeters. Therefore, a recommended strategy is to contemplate combining TACE with either an immune checkpoint inhibitor or alternative treatments like radiofrequency ablation and microwave ablation.

The overarching goal is to advocate for a combination approach involving TACE and other treatments for lesions exceeding five centimeters. However, our understanding would benefit from more extensive research. While our paper focused on six studies, a broader range of studies, randomized control trials, and exploration of additional drugs, especially immune checkpoint inhibitors, is imperative. This comprehensive approach aims to identify the most efficacious and safe drug. Notably, some drugs, such as sorafenib, have shown efficacy but reported serious adverse effects, underscoring the importance of assessing both effectiveness and safety in the pursuit of optimal treatment options.

Is there anything else you would like to share about your research?

Dr. Tashrifwala: Another aspect worth discussing is the timing of TACE administration in conjunction with the tumor stage. The referenced paper delves into microwave frequency ablation and radiofrequency ablation. It underscores the significance of individualized patient study, emphasizing the need to focus on the tumor site rather than solely considering its size. Factors such as the tumor’s localization, whether it remains local or has metastasized, should be carefully examined before determining the appropriate course of action.

TACE Plus Camrelizumab for Treating Advanced, Recurrent, Unresectable HCC

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