Hepatic Arterial Infusion Chemotherapy New-FP for Hepatocellular Carcinoma with Major Portal Vein Tumor Thrombus

Abstract Background/Purpose: Although macrovascular invasion (MVI), particularly major portal vein tumor thrombus (PVTT), is a critical tumor condition in hepatocellular carcinoma (HCC), determining the optimal treatment is an unmet medical need. We aimed to compare the efficacy of hepatic arterial infusion chemotherapy (HAIC) regimens New-FP (fine-powder cisplatin/ lipiodol suspension and 5-fluorouracil) and sorafenib for MVI-HCC and major PVTT-HCC in patients with preserved liver function. Methods: We retrospectively analyzed 1,709 consecutively presenting patients with HCC who were initially treated with New-FP or sorafenib (March 2009 to June 2019). Overall survival and prognostic factors were assessed in both groups after propensity score matching (n=198 each). Subgroup analyses were conducted in four groups: cohort 1 (no MVI or extrahepatic spread [EHS]), cohort 2 (MVI only), cohort 3 (EHS only), and cohort 4 (MVI and EHS). Cohort 5 evaluated major PVTT (including EHS). Results: The New-FP group had a longer median survival time (MST) than the sorafenib group (New-FP, 18 months; sorafenib, nine months; p<0.0001). New-FP demonstrated a statistically longer MST compared with sorafenib in cohorts 2 and 4. In cohort 5, the MST of the New-FP group was 16 months, while that of sorafenib was six months (p<0.0001). For major PVTT-HCC, the objective response rate for New-FP was 73.0%. The MST of patients who achieved a complete response with New-FP (16.6%) was 59 months. Conclusion: New-FP showed significant efficacy for MVI-HCC, including major PVTT-HCC. Even in the era of systemic treatment, HAIC using New-FP is a promising modality for patients with advanced HCC.