Safety and efficacy of biliary stenting combined with iodine-125 seed strand followed by hepatic artery infusion chemotherapy plus lenvatinib with PD-1 inhibitor for the treatment of extrahepatic cholangiocarcinoma with malignant obstructive jaundice

Front Immunol. 2024 Jan 15:14:1286771. doi: 10.3389/fimmu.2023.1286771. eCollection 2023.

Abstract

Objectives: To evaluate the efficacy and safety of biliary stenting implantation with iodine-125 seed strand (SI) followed by hepatic artery infusion chemotherapy (HAIC) plus lenvatinib (Len) with programmed death-1 (PD-1) inhibitor for patients diagnosed with extrahepatic cholangiocarcinoma (ECC) and malignant obstructive jaundice (MOJ).

Methods: In this single-center retrospective study, the data of ECC patients with MOJ from March 2015 to January 2023 was assessed. Using probability score matching (PSM), the selection bias of patients was reduced. Primary study outcomes included overall survival (OS) and progression-free survival (PFS). The OS and PFS were performed using the Kaplan-Meier method and evaluated with the log-rank test.

Results: A total of 104 patients were enrolled finally, including 52 patients treated with interventional therapy (SI+HAIC) plus Len with PD-1 inhibitor (SI+HAIC+Len+P group) and 52 patients treated with interventional therapy (SI+HAIC) plus lenvatinib (SI+HAIC+Len group). 26 pairs of patients were matched after PSM analysis. After PSM analysis, the median OS and PFS in the SI+HAIC+Len+P group were significantly longer compared to those in the SI+HAIC+Len group (OS:16.6 vs. 12.3 months, P = 0.001; PFS:12.6 vs 8.5 months, P = 0.004). The DCR was significantly different between groups (P = 0.039), while ORR not (P = 0.548). The addition of PD-1 inhibitor was generally well tolerated without treatment-associated mortality.

Conclusion: Interventional therapy (SI+HAIC) plus Len with PD-1 inhibitor was effective for ECC patients accompanied by MOJ with a manageable safety profile.

Keywords: extrahepatic cholangiocarcinoma; hepatic artery infusion chemotherapy; iodine-125 seed strand; lenvatinib; programmed death-1 inhibitor.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Bile Duct Neoplasms* / complications
  • Bile Duct Neoplasms* / therapy
  • Bile Ducts, Intrahepatic
  • Cholangiocarcinoma* / complications
  • Cholangiocarcinoma* / therapy
  • Hepatic Artery
  • Humans
  • Immune Checkpoint Inhibitors
  • Iodine Radioisotopes*
  • Jaundice, Obstructive*
  • Phenylurea Compounds*
  • Quinolines*
  • Retrospective Studies

Substances

  • Iodine-125
  • lenvatinib
  • Immune Checkpoint Inhibitors
  • Iodine Radioisotopes
  • Phenylurea Compounds
  • Quinolines

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work was supported by grants from the Fujian Province Joint Funds for the Innovation of Science and Technology (no. 2100201).