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.
Zhou et al. (Fri,) studied this question.