Drug-eluting bead transarterial chemoembolization combined with immune checkpoint inhibitors is associated with improved progression-free survival in locally advanced or metastatic sarcoma: a retrospective propensity score-matched analysis.

BACKGROUND

Immune checkpoint inhibitors (ICIs) have shown limited efficacy in unselected advanced sarcomas. Drug-eluting bead transarterial chemoembolization (dTACE) may enhance antitumor immunity through localized chemotherapy and immunogenic cell death.

OBJECTIVES

This study aimed to evaluate the clinical benefits of combining dTACE with ICIs-based therapy in locally advanced or metastatic sarcomas.

DESIGN

This was a retrospective study.

METHODS

In this retrospective, exploratory cohort study (May 2019-July 2024), patients receiving ICIs-based therapy (ICIs ± chemotherapy ± tyrosine kinase inhibitors) were stratified into two groups: systemic therapy alone (ICIs-based therapy) or combined with dTACE (ICIs-dTACE). Propensity score matching (PSM) was used to address selection bias and balance baseline characteristics.

RESULTS

A total of 213 patients were included (167 in the ICIs-based therapy group and 46 in the ICIs-dTACE group), yielding 44 matched pairs after PSM. The ICIs-dTACE group was associated with significantly superior median progression-free survival (PFS) compared to the ICIs-based therapy group (7.9 vs 4.5 months; hazard ratio (HR) = 0.532, 95% confidence interval (CI) 0.339-0.836; log-rank p = 0.005). This association remained consistent after PSM (7.9 vs 4.7 months; HR = 0.533, 95% CI 0.312-0.910; log-rank p = 0.019). The disease control rate was also higher in the ICIs-dTACE group both before (87.0% vs 71.9%, p = 0.036) and after PSM (88.6% vs 70.5%, p = 0.034). Multivariate analysis identified ICIs-dTACE as an independent predictor for improved PFS (post-PSM: HR = 0.522, 95% CI 0.284-0.959; p = 0.036). Notably, 16 patients (34.8%) in the ICIs-dTACE group underwent surgical resection, achieving an R0 resection rate of 87.5% (14/16) and a major pathological response (⩾90% necrosis) in 50.0% (8/16). The safety profiles were comparable between groups, with grade ⩾3 adverse events (AEs) primarily attributable to chemotherapy. No grade 3 or higher AEs were attributed to dTACE.

CONCLUSION

In this exploratory analysis, the addition of dTACE to ICIs-based therapy was associated with improved PFS and enabled surgical resection in a subset of patients with advanced sarcoma, without introducing additional severe toxicity. These findings suggest the synergistic potential of this combined modality and warrant prospective validation.