Apatinib Administration Following Transcatheter Arterial Chemoembolization For Hepatocellular Carcinoma With Pulmonary Metastasis: A Single-Institutional Experience

e16104 Background: Prognosis of advanced hepatocellular carcinoma (HCC) with pulmonary metastases is poor. Anti-angiogenesis therapy plus transcatheter arterial chemoembolization (TACE, the mainstay of local-regional treatment) seems to be a promising strategy. Apatinib, an oral tyrosine kinase inhibitor targeting VEGFR-2, has been proven to be effective in advanced HCC. This observational study aimed to evaluate apatinib for pulmonary metastases in HCC patients following TACE procedure. Methods: From May 2015 to Jun 2017, advanced HCC with lung metastasis, who underwent TACE for the primary liver tumor and then received apatinib (500 mg qd) treatment, were included. The tumor responses were assessed according to the Response Evaluation Criteria in Solid Tumors (RECIST 1.1) and the safety profiles were recorded according to the National Cancer Institute-Common Terminology Criteria for Adverse Events (NCI-CTCAE 4.0). Results: Total 38 cases were included. The baseline data are shown in Table 1. The median medication time was 11.4 months (range 0.4–31.6). Among 30 assessable patients, 1 had a complete response, 14 had a partial response, 10 had stable disease, and 5 had progressive disease. An objective response rate of 50.0% was achieved, and the disease control rate was 83.3%. At the cut-off date of Nov 21 2017, the median progression-free survival was 10.1 months (95%CI, 3.5–14.8 months). The median overall survival had not reached, and the 12-month survival rate was 69.1%. The most common adverse events (AEs) related to apatinib were anemia, fatigue, and bilirubin increase. No unexpected AEs occurred. Conclusions: On the basis of TACE treatment for primary lesions, subsequent apatinib lead to an obvious good response of pulmonary metastases. TACE combined with apatinib could be an alternative first-line treatment for HCC patients with pulmonary metastases. Table 1 Baseline Data. Characteristics N (%) Age, yrs N (Missing) 37 (1) Median (Range) 51 (30, 66) Gender N (missing) 38 (0) Male 29 (76.3%) ECOG PS N (missing) 29 (9) 0-1 26 (89.7%) 2 3 (10.3%) Child-Pugh N (missing) 32 (6) A 27 (84.4%) B 5 (15.6%) BCLC N (missing) 32 (6) C 32 (100.0%)