ORIGINAL RESEARCH article
Front. Oncol.
Sec. Gastrointestinal Cancers: Hepato Pancreatic Biliary Cancers
Volume 15 - 2025 | doi: 10.3389/fonc.2025.1570807
Efficacy of Pembrolizumab with or without Lenvatinib in Unresectable Hepatocellular Carcinoma with Portal Vein Tumor Thrombus in Patients Following Transjugular Intrahepatic Portosystemic Shunt
Provisionally accepted
Jiaqi Chen1
Weiguang Yu2*
Jiang Hua Lou1Yang Zhao1Qiang Tang1Yunxiang Zhang1Yijie Zhang1Haoyu Zhang1Zhong Zhang1Xiaoyan Zhang1Xiaobo Xia1*- 1Henan Provincial People's Hospital, Zhengzhou, Henan Province, China
- 2Sun Yat-sen University, Guangzhou, China
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The clinical management of unresectable hepatocellular carcinoma (uHCC) complicated by portal vein tumor thrombus (PVTT) following transjugular intrahepatic portosystemic shunt (TIPS) remains understudied. This retrospective study compares the efficacy and safety of pembrolizumab-lenvatinib combination therapy (PL) versus pembrolizumab monotherapy (PM), particularly focusing on high PD-L1 expression subgroups (combined positive score [CPS] ≥20%).Methods: Patients with uHCC and PVTT post-TIPS (2017-2024) from two Chinese tertiary centers were retrospectively reviewed. Propensity score matching (PSM) was applied to adjust for baseline characteristics. The primary endpoint was progression-free survival (PFS), and overall survival (OS) served as a secondary endpoint.Results: Among 246 patients (PL: n=120; PM: n=126), PL significantly prolonged PFS (8.0 vs. 5.9 months, HR=0.65, p<0.001) and OS (28.0 vs. 17.0 months, HR=0.58, p<0.001) compared to PM. The benefit was most pronounced in patients with high CPS (OS: 29.7 vs. 19.0 months, HR=0.57, p<0.001). Grade ≥3 adverse events were more frequent in the PL group (54.2% vs. 39.7%).Conclusions: PL improves survival outcomes over PM in TIPS-managed uHCC patients with PVTT, especially among those with high PD-L1 expression. These findings support a personalized immunotherapy strategy integrating CPS stratification.
Keywords: Pembrolizumab, Lenvatinib, Hepatocellular Carcinoma, CPS, Progression-free survival, Portal vein tumor thrombus
Received: 04 Feb 2025; Accepted: 27 May 2025.
Copyright: © 2025 Chen, Yu, Lou, Zhao, Tang, Zhang, Zhang, Zhang, Zhang, Zhang and Xia. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Weiguang Yu, Sun Yat-sen University, Guangzhou, China
Xiaobo Xia, Henan Provincial People's Hospital, Zhengzhou, 450000, Henan Province, China
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