HAIC Combine With Lenvatinib and PD-1 Inhibitors for Advanced HCC With PVTT

Prior treatment

• History of usage of immune inhibitor drug within 14 days before the injection of PD-1 inhibitors, except nasal spray and inhaled corticosteroids or physiological doses of systemic steroid hormones (no more than 10 mg/day of prednisolone or other corticosteroids with equivalent physiological doses).
• Vaccination with live attenuated vaccine within 4 weeks before the first dose or planned during the study period.
• Clinically significant cardiovascular disease, including, but not limited to, acute myocardial infarction, severe/unstable angina or prior coronary artery bypass surgery, congestive heart failure (NYHA \>2), poorly controlled arrhythmias or arrhythmias requiring pacemaker therapy, hypertension not controlled by medication (systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg) within the past 6 months.
• History of significant coughing up blood 2 months before entering the study, or the daily volume of hemoptysis reached 2.5 ml or more.
• Complicated infections requiring drug intervention (such as intravenous infusion of antibiotics, antifungal or antiviral drugs) within 4 weeks before the first treatment, or unexplained fever \>38.5°C during the screening period/before the first administration.
• Participated in any other clinical research within 4 weeks before the first treatment.

Other illness

• History of malignant tumor, excluding the following cases:
• Allergic to contrast agent.
• Allergic to oxaliplatin.
• Factors influenced oral Lenvatinib, such as inability to swallow, chronic diarrhea and intestinal obstruction, or other conditions that significantly affect the administration and absorption of the drug.
• Allergic to Lenvatinib, PD-1 inhibitors, and other mono-colonal antibodies.
• History of active autoimmune disease or autoimmune disease.
• History of other malignant tumor, except for radically treated basal cell, squamous cell skin cancer, or cervical carcinoma in situ.
• History of human immunodeficiency virus (HIV) infection or acquired immunodeficiency syndrome (AIDS) .
• History of inherited or acquired bleeding and thrombotic tendency, such as hemophilia, coagulopathy, thrombocytopenia, hypersplenism, etc..
• Patients at risk of gastrointestinal bleeding, including the following:
  • There are active peptic ulcer lesions.
  • Those who have a history of melena and hematemesis within 3 months.
  • For fecal occult blood (+) or (+/-), it is necessary to recheck the stool routine within 1 week. Those who still (+) or (+/-) must undergo gastroscopy. If there is ulcer, bleeding disease, and the treating physician believes that there is a potential risk of bleeding.
• History of thrombosis and/or embolism within 6 months of the start of treatment.
• History of psychotropic drug abuse or drug use.

Lab values

• Abnormal coagulation function (INR\>1.5 or APTT\>1.5×ULN) , have bleeding tendency, or are receiving thrombolytic therapy, anticoagulation therapy or antiplatelet therapy, etc..
• Other serious physical, mental illnesses or laboratory abnormalities, which may increase the risk of participating in the research or interfere with the results of the research, and those who the researcher believes are not suitable for participating in this research.

Other

• Fibrolamellar hepatocellular carcinoma, sarcomatoid hepatocellular carcinoma, cholangiocarcinoma confirmed by histology or cytology.
• Peripheral neuropathy\> Grade 1.

• Age and gender: \>18 years old and≤75 years old, both men and women.
• All subjects must have advanced hepatocellular carcinoma with portal vein tumor thrombosis confirmed by pathological or clinical diagnosis.
• One measurable lesion at least.
• ECOG PS 0-1 before 1 week of treatment begnining.
• Child-Pugh class A; ALBI class 1-2.
• Systemic-cheomtherapy-naive and HAIC-naive.
• BCLC C stage with PVTT (Vp1 - Vp4).
• Without distant metastasis.
• Patients who are expected to live more than 3 months.
• Subjects must volunteer to participate in the study, signed informed consent, and were able to comply with the program requirements of visits and related procedures.
• Patients with laboratory values that meet the following criteria:
  • Hemoglobin≥90 g/L;
  • Neutrophile granulocytes≥1.5×109/L;
  • Platelet count≥75×109/L;
  • Albumin≥30 g/L;
  • Total serum bilirubin ≤ 2 times upper limits of normal;
  • AST and ALT ≤ 5 times upper limits of normal;
  • Serum creatinine ≤ 1.5 times upper limits of normal;
  • Alkaline phosphatase ≤ 5 times upper limits of normal;
  • Prothrombin time or international normalized ratio ≤ 1.5 times upper limits of normal, activated partial thromboplastin time (APTT) ≤ 1.5×ULN.