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  • 1. Aims and Scope

    Gut and Liver is an international journal of gastroenterology, focusing on the gastrointestinal tract, liver, biliary tree, pancreas, motility, and neurogastroenterology. Gut atnd Liver delivers up-to-date, authoritative papers on both clinical and research-based topics in gastroenterology. The Journal publishes original articles, case reports, brief communications, letters to the editor and invited review articles in the field of gastroenterology. The Journal is operated by internationally renowned editorial boards and designed to provide a global opportunity to promote academic developments in the field of gastroenterology and hepatology. +MORE

  • 2. Editorial Board

    Editor-in-Chief + MORE

    Editor-in-Chief
    Yong Chan Lee Professor of Medicine
    Director, Gastrointestinal Research Laboratory
    Veterans Affairs Medical Center, Univ. California San Francisco
    San Francisco, USA

    Deputy Editor

    Deputy Editor
    Jong Pil Im Seoul National University College of Medicine, Seoul, Korea
    Robert S. Bresalier University of Texas M. D. Anderson Cancer Center, Houston, USA
    Steven H. Itzkowitz Mount Sinai Medical Center, NY, USA
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    All papers submitted to Gut and Liver are reviewed by the editorial team before being sent out for an external peer review to rule out papers that have low priority, insufficient originality, scientific flaws, or the absence of a message of importance to the readers of the Journal. A decision about these papers will usually be made within two or three weeks.
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Letter to the Editor

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Comments on Comparison of Sorafenib versus Hepatic Arterial Infusion Chemotherapy-Based Treatment for Advanced Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis

Min Deng1,2 , Shaohua Li1,2 , Wei Wei1,2 , Rongping Guo1,2

1Department of Liver Surgery, Sun Yat-sen University Cancer Center, and 2State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China

Correspondence to: Rongping Guo
ORCID https://orcid.org/0000-0003-2799-3463
E-mail guorp@sysucc.org.cn

Received: June 8, 2022; Revised: June 21, 2022; Accepted: June 27, 2022

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Gut Liver 2023;17(2):339-340. https://doi.org/10.5009/gnl220249

Published online February 15, 2023, Published date March 15, 2023

Copyright © Gut and Liver.

To the Editor:

We read with great interest the recent research by Ahn et al.,1 which reported that hepatic arterial infusion chemotherapy (HAIC)-based therapy may have a potential therapeutic advantage over sorafenib for advanced hepatocellular carcinoma (HCC) with main portal vein tumor thrombosis in Korea University Medical Center. HAIC therapy shows superior efficacy in terms of the disease control rate and time-to-progression to sorafenib treatment.

HAIC has been reported to have not only satisfactory efficacy in advanced liver cancer, including HCC and intrahepatic cholangiocarcinoma, but also a survival benefit for patients who received hepatectomy.2-4 Although the overall survival of the HAIC-based and sorafenib-based groups in this study was not significantly different, which may be due to the relatively small sample size, it can be seen from the trend of the survival curve that HAIC has a better prognosis.

I would like to raise a few questions to the authors of this study. First, the article mentioned HAIC and sorafenib combination therapies, but the specific combination information was not provided, such as the presence or absence of transarterial chemoembolization or immunotherapy. In recent years, immunotherapy has achieved satisfactory efficacy in many cancers, including HCC, and plays a critical role in systemic therapy.5-7 For instance, atezolizumab plus bevacizumab has been used as a first-line systemic strategy for treating advanced HCC.8 Moreover, one study has reported that HAIC combined with anti-PD-1 immunotherapy can improve the efficacy of HAIC, which is better than monotherapy.9

Second, this article reported that the proportion of adverse events following HAIC was high, and many cases were in grades 3 and 4. At baseline, 29% of patients had Child-Pugh class B before HAIC, and there was a lack of assessment of liver cirrhosis. It has been confirmed that patients treated with HAIC should have good performance status and reserved liver function.10 It is recommended that patients should be in Child-Pugh class A, or after liver protection, that the liver function is restored to Child-Pugh class A, and performance status ≤2.11

Third, the protocol of HAIC in this research is cisplatin and 5-flurouracil, which was infused via the chemoport. Studies have reported that FOLFOX (folinic acid, 5-fluorouracil, and oxaliplatin) HAIC has an apparent curative efficacy.12,13 The above studies reported that any implanted port system was not applied for FOLFOX HAIC. The catheter was removed when HAIC was completed. The HAIC regimen comprised oxaliplatin (135 mg/m2 from hour 0 to 3 on day 1), leucovorin (400 mg/m2 from hour 3 to 4.5 on day 1), fluorouracil (400 mg/m2 from hour 4.5 to 6.5 on day 1), and fluorouracil (2,400 mg/m2 over 46 hours from day 1 to day 3). HAIC was performed once every 3 to 4 weeks and repetitive catheterization was performed in the next cycle.3,12 Your team can consider this regimen in future clinical research or treatment.

Therefore, HAIC has good therapeutic prospects, and further studies with large-scale and more detailed clinical information are needed to assess the efficacy of HAIC.

No potential conflict of interest relevant to this article was reported.

  1. Ahn YE, Suh SJ, Yim HJ, et al. Comparison of sorafenib versus hepatic arterial infusion chemotherapy-based treatment for advanced hepatocellular carcinoma with portal vein tumor thrombosis. Gut Liver 2021;15:284-294.
    Pubmed KoreaMed CrossRef
  2. Li S, Mei J, Wang Q, et al. Transarterial infusion chemotherapy with FOLFOX for advanced hepatocellular carcinoma: a multi-center propensity score matched analysis of real-world practice. Hepatobiliary Surg Nutr 2021;10:631-645.
    Pubmed KoreaMed CrossRef
  3. Li S, Deng M, Wang Q, et al. Transarterial infusion chemotherapy with FOLFOX could be an effective and safe treatment for unresectable intrahepatic cholangiocarcinoma. J Oncol 2022;2022:2724476.
    Pubmed KoreaMed CrossRef
  4. Li S, Zhong C, Li Q, et al. Neoadjuvant transarterial infusion chemotherapy with FOLFOX could improve outcomes of resectable BCLC stage A/B hepatocellular carcinoma patients beyond Milan criteria: an interim analysis of a multi-center, phase 3, randomized, controlled clinical trial. J Clin Oncol 2021;39(15_suppl):4008.
    CrossRef
  5. Lan XB, Papatheodoridis G, Teng YX, Zhong JH. The upward trend in the immunotherapy utilization for hepatobiliary cancers. Hepatobiliary Surg Nutr 2021;10:692-695.
    Pubmed KoreaMed CrossRef
  6. Campani C, Nault JC. Systemic treatment of hepatocellular carcinoma: the times they are a-changin'. Hepatobiliary Surg Nutr 2021;10:893-895.
    Pubmed KoreaMed CrossRef
  7. Deng M, Li S, Wang Q, et al. Real-world outcomes of patients with advanced intrahepatic cholangiocarcinoma treated with programmed cell death protein-1-targeted immunotherapy. Ann Med 2022;54:803-811.
    Pubmed KoreaMed CrossRef
  8. Finn RS, Qin S, Ikeda M, et al. Atezolizumab plus bevacizumab in unresectable hepatocellular carcinoma. N Engl J Med 2020;382:1894-1905.
    Pubmed CrossRef
  9. Mei J, Li SH, Li QJ, et al. Anti-PD-1 immunotherapy improves the efficacy of hepatic artery infusion chemotherapy in advanced hepatocellular carcinoma. J Hepatocell Carcinoma 2021;8:167-176.
    Pubmed KoreaMed CrossRef
  10. Obi S, Sato S, Kawai T. Current status of hepatic arterial infusion chemotherapy. Liver Cancer 2015;4:188-199.
    Pubmed KoreaMed CrossRef
  11. Zhou J, Sun H, Wang Z, et al. Guidelines for the diagnosis and treatment of hepatocellular carcinoma (2019 edition). Liver Cancer 2020;9:682-720.
    Pubmed KoreaMed CrossRef
  12. He M, Li Q, Zou R, et al. Sorafenib plus hepatic arterial infusion of oxaliplatin, fluorouracil, and leucovorin vs sorafenib alone for hepatocellular carcinoma with portal vein invasion: a randomized clinical trial. JAMA Oncol 2019;5:953-960.
    Pubmed KoreaMed CrossRef
  13. Li QJ, He MK, Chen HW, et al. Hepatic arterial infusion of oxaliplatin, fluorouracil, and leucovorin versus transarterial chemoembolization for large hepatocellular carcinoma: a randomized phase III trial. J Clin Oncol 2022;40:150-160.
    Pubmed CrossRef

Article

Letter to the Editor

Gut and Liver 2023; 17(2): 339-340

Published online March 15, 2023 https://doi.org/10.5009/gnl220249

Copyright © Gut and Liver.

Comments on Comparison of Sorafenib versus Hepatic Arterial Infusion Chemotherapy-Based Treatment for Advanced Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis

Min Deng1,2 , Shaohua Li1,2 , Wei Wei1,2 , Rongping Guo1,2

1Department of Liver Surgery, Sun Yat-sen University Cancer Center, and 2State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China

Correspondence to:Rongping Guo
ORCID https://orcid.org/0000-0003-2799-3463
E-mail guorp@sysucc.org.cn

Received: June 8, 2022; Revised: June 21, 2022; Accepted: June 27, 2022

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Body

To the Editor:

We read with great interest the recent research by Ahn et al.,1 which reported that hepatic arterial infusion chemotherapy (HAIC)-based therapy may have a potential therapeutic advantage over sorafenib for advanced hepatocellular carcinoma (HCC) with main portal vein tumor thrombosis in Korea University Medical Center. HAIC therapy shows superior efficacy in terms of the disease control rate and time-to-progression to sorafenib treatment.

HAIC has been reported to have not only satisfactory efficacy in advanced liver cancer, including HCC and intrahepatic cholangiocarcinoma, but also a survival benefit for patients who received hepatectomy.2-4 Although the overall survival of the HAIC-based and sorafenib-based groups in this study was not significantly different, which may be due to the relatively small sample size, it can be seen from the trend of the survival curve that HAIC has a better prognosis.

I would like to raise a few questions to the authors of this study. First, the article mentioned HAIC and sorafenib combination therapies, but the specific combination information was not provided, such as the presence or absence of transarterial chemoembolization or immunotherapy. In recent years, immunotherapy has achieved satisfactory efficacy in many cancers, including HCC, and plays a critical role in systemic therapy.5-7 For instance, atezolizumab plus bevacizumab has been used as a first-line systemic strategy for treating advanced HCC.8 Moreover, one study has reported that HAIC combined with anti-PD-1 immunotherapy can improve the efficacy of HAIC, which is better than monotherapy.9

Second, this article reported that the proportion of adverse events following HAIC was high, and many cases were in grades 3 and 4. At baseline, 29% of patients had Child-Pugh class B before HAIC, and there was a lack of assessment of liver cirrhosis. It has been confirmed that patients treated with HAIC should have good performance status and reserved liver function.10 It is recommended that patients should be in Child-Pugh class A, or after liver protection, that the liver function is restored to Child-Pugh class A, and performance status ≤2.11

Third, the protocol of HAIC in this research is cisplatin and 5-flurouracil, which was infused via the chemoport. Studies have reported that FOLFOX (folinic acid, 5-fluorouracil, and oxaliplatin) HAIC has an apparent curative efficacy.12,13 The above studies reported that any implanted port system was not applied for FOLFOX HAIC. The catheter was removed when HAIC was completed. The HAIC regimen comprised oxaliplatin (135 mg/m2 from hour 0 to 3 on day 1), leucovorin (400 mg/m2 from hour 3 to 4.5 on day 1), fluorouracil (400 mg/m2 from hour 4.5 to 6.5 on day 1), and fluorouracil (2,400 mg/m2 over 46 hours from day 1 to day 3). HAIC was performed once every 3 to 4 weeks and repetitive catheterization was performed in the next cycle.3,12 Your team can consider this regimen in future clinical research or treatment.

Therefore, HAIC has good therapeutic prospects, and further studies with large-scale and more detailed clinical information are needed to assess the efficacy of HAIC.

CONFLICTS OF INTEREST

No potential conflict of interest relevant to this article was reported.

References

  1. Ahn YE, Suh SJ, Yim HJ, et al. Comparison of sorafenib versus hepatic arterial infusion chemotherapy-based treatment for advanced hepatocellular carcinoma with portal vein tumor thrombosis. Gut Liver 2021;15:284-294.
    Pubmed KoreaMed CrossRef
  2. Li S, Mei J, Wang Q, et al. Transarterial infusion chemotherapy with FOLFOX for advanced hepatocellular carcinoma: a multi-center propensity score matched analysis of real-world practice. Hepatobiliary Surg Nutr 2021;10:631-645.
    Pubmed KoreaMed CrossRef
  3. Li S, Deng M, Wang Q, et al. Transarterial infusion chemotherapy with FOLFOX could be an effective and safe treatment for unresectable intrahepatic cholangiocarcinoma. J Oncol 2022;2022:2724476.
    Pubmed KoreaMed CrossRef
  4. Li S, Zhong C, Li Q, et al. Neoadjuvant transarterial infusion chemotherapy with FOLFOX could improve outcomes of resectable BCLC stage A/B hepatocellular carcinoma patients beyond Milan criteria: an interim analysis of a multi-center, phase 3, randomized, controlled clinical trial. J Clin Oncol 2021;39(15_suppl):4008.
    CrossRef
  5. Lan XB, Papatheodoridis G, Teng YX, Zhong JH. The upward trend in the immunotherapy utilization for hepatobiliary cancers. Hepatobiliary Surg Nutr 2021;10:692-695.
    Pubmed KoreaMed CrossRef
  6. Campani C, Nault JC. Systemic treatment of hepatocellular carcinoma: the times they are a-changin'. Hepatobiliary Surg Nutr 2021;10:893-895.
    Pubmed KoreaMed CrossRef
  7. Deng M, Li S, Wang Q, et al. Real-world outcomes of patients with advanced intrahepatic cholangiocarcinoma treated with programmed cell death protein-1-targeted immunotherapy. Ann Med 2022;54:803-811.
    Pubmed KoreaMed CrossRef
  8. Finn RS, Qin S, Ikeda M, et al. Atezolizumab plus bevacizumab in unresectable hepatocellular carcinoma. N Engl J Med 2020;382:1894-1905.
    Pubmed CrossRef
  9. Mei J, Li SH, Li QJ, et al. Anti-PD-1 immunotherapy improves the efficacy of hepatic artery infusion chemotherapy in advanced hepatocellular carcinoma. J Hepatocell Carcinoma 2021;8:167-176.
    Pubmed KoreaMed CrossRef
  10. Obi S, Sato S, Kawai T. Current status of hepatic arterial infusion chemotherapy. Liver Cancer 2015;4:188-199.
    Pubmed KoreaMed CrossRef
  11. Zhou J, Sun H, Wang Z, et al. Guidelines for the diagnosis and treatment of hepatocellular carcinoma (2019 edition). Liver Cancer 2020;9:682-720.
    Pubmed KoreaMed CrossRef
  12. He M, Li Q, Zou R, et al. Sorafenib plus hepatic arterial infusion of oxaliplatin, fluorouracil, and leucovorin vs sorafenib alone for hepatocellular carcinoma with portal vein invasion: a randomized clinical trial. JAMA Oncol 2019;5:953-960.
    Pubmed KoreaMed CrossRef
  13. Li QJ, He MK, Chen HW, et al. Hepatic arterial infusion of oxaliplatin, fluorouracil, and leucovorin versus transarterial chemoembolization for large hepatocellular carcinoma: a randomized phase III trial. J Clin Oncol 2022;40:150-160.
    Pubmed CrossRef
Gut and Liver

Vol.18 No.2
March, 2024

pISSN 1976-2283
eISSN 2005-1212

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