Procedures
tumor, liver and kidney failure, Tumor, Tumors, tumors, adverse drug reactions
DISEASE PROGRESSION, TUMOR, TUMOR, COMPLICATION, SOLID TUMOR, TUMORS, ADVERSE REACTION, SYNDROME, ADVERSE EVENT, TUMORS, ADVERSE DRUG REACTIONS
During the treatment of TACE, the Seldinger method was used for percutaneous femoral artery catheterization with catheter placed in the abdominal trunk and the common hepatic artery for DSA imaging. The imaging images were collected, including the arterial, parenchymal, and venous phases. In some patients, the superior mesenteric artery, right renal artery, and right phrenic artery were performed to find the blood supply of tumor collateral when necessary. The microcatheter was used to superselect tumor supplying arteries, and all tumor supplying arteries should be superselected successively according to the results of arteriography. The chemotherapy drugs included epirubicin hydrochloride 40-80 mg and oxaliplatin 100 mg. One part of the chemotherapy drugs was injected through the microcatheter, and then the other part was mixed with epirubicin and hydroxycamtocrin and iodide to form an emulsion. At the same time, granular embolization agents (polyvinyl alcohol granules and gelatin sponge granules) were injected alternately for combined embolization. After embolization was complete, angiography was performed again to determine whether the tumor was completely embolized. If there was a local deficiency, embolization was continued until angiography showed complete embolization. Large tumors and multiple tumors in the left and right lobes were treated with TACE twice to prevent liver and kidney failure.Oral TKI medication should be started within one week after the syndrome was relieved after TACE therapy. The three available TKIs were sorafenib (400 mg, twice a day), regorafenib (80-160 mg, once daily, for 21 days, 7 days off), and lenvatinib. For lenvatinib, patients with a body mass of ≥ 60 kg received an initial dose of 12 mg once a day, and patients with a body mass of < 60 kg received an initial dose of 8 mg once a day. Discontinue TKI medication 3 days before and after TACE treatment. When the patient had a large adverse reaction, the dose of the TKI drug was reduced or taken orally every other day. When adverse drug reactions cannot be tolerated, the medication was discontinued.Camrelizumab (200 mg intravenously) was administered within two weeks after the syndrome was relieved after TACE treatment and repeated every 3 weeks. If an immunotherapy-related serious adverse event (irSAE) occurred, camrelizumab was discontinued, and immunosuppressants were administered depending on the severity of the complication and the affected organ.Tumor imaging was conducted at baseline, week 6, week 12, week 18, week 24, and then every 9 weeks thereafter, by contrast-enhanced computed tomography and magnetic resonance imaging. The response was assessed on the basis of the Response Evaluation Criteria in Solid Tumors version 1.1 and Modified solid tumor Evaluation Criteria.Early combination therapy was defined as treatment with camrelizumab and TKI prior to the first TACE treatment. Late-stage combination therapy was defined as treatment with camrelizumab and TKI after the first TACE treatment. The timing of the use of camrelizumab in combination with TKI was determined by the physician and patient. Excision was performed after a successful descent with sufficient future residual liver (FLR). If researchers observed evidence of clinical benefit, patients may continue the combination therapy after disease progression or be treated with monotherapy.