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Anti-PD-1 combined sorafenib versus antiPD-1 alone in the treatment of advanced hepatocellular cell carcinoma: A propensity score-matching study

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Vascular endothelial growth factor (VEGF) plays a role in the tumor microenvironment. Sorafenib, which inhibits the VEGF pathway, has an immune-modulation function but lacks substantial clinical data. This study aims to explore the efficacy of anti-PD-1 combined sorafenib in advanced hepatocellular carcinoma (HCC). | Chen et al. BMC Cancer 2022 22 55 https doi.org 10.1186 s12885-022-09173-4 RESEARCH Open Access Anti-PD-1 combined sorafenib versus anti- PD-1 alone in the treatment of advanced hepatocellular cell carcinoma a propensity score-matching study San Chi Chen1 2 3 Yi Hsiang Huang1 2 4 Ming Huang Chen1 2 3 Yi Ping Hung1 2 3 Rheun Chuan Lee5 Yu Yun Shao6 7 8 and Yee Chao1 2 3 Abstract Background Vascular endothelial growth factor VEGF plays a role in the tumor microenvironment. Sorafenib which inhibits the VEGF pathway has an immune-modulation function but lacks substantial clinical data. This study aims to explore the efficacy of anti-PD-1 combined sorafenib in advanced hepatocellular carcinoma HCC . Methods HCC patients who underwent anti-PD-1 treatment at Taipei Veterans General Hospital Taipei Taiwan between January 2016 and February 2019 were reviewed. The efficacy was compared between groups after propen sity-score matching. Results There were 173 HCC patients receiving anti-PD-1. After excluding unsuitable cases 140 patients were analyzed of which 58 received combination therapy and 82 received anti-PD-1 alone. The combination therapy had a trend of higher CR rate 8.6 vs. 4.9 ns. ORR 22.4 vs. 19.5 ns. and significantly higher DCR 69.0 vs. 37.8 p 66 the higher the ORR 70 80 and 92 and CR rates 30 35 and 58 were achieved at day 28. Conclusions This is the first study to demonstrate the combination of anti-PD-1 and sorafenib had better efficacy and survival benefit. A prospective randomized study is needed to confirm this finding. Keywords Hepatocellular carcinoma HCC Anti-PD-1 Nivolumab Pembrolizumab Sorafenib Multiple-kinase inhibitor Vascular endothelial growth factor VEGF Combination therapy Propensity score matching PSM Background HCC is the second most common cause of cancer- related death in Taiwan 1 and ranks fourth worldwide 2 . In advanced HCC the prognosis is poor and treat- Correspondence ychao@vghtpe.gov.tw ment options are limited. In recent years .