Drug Combo Ups Ulcer Risk After Cryoablation in Patients With HCC

M. Alexander Otto, MMS, PA

March 07, 2022

The study covered in this summary was published on researchsquare.com as a preprint and has not yet been peer reviewed.

Key Takeaways

  • Patients with hepatocellular carcinoma (HCC) receiving PD-1 antibodies and antiangiogenic tyrosine kinase inhibitors (TKIs) within 2 months of cryoablation for superficial metastases are at an increased risk of thoracoabdominal wall ulcer.

  • The authors conclude that this combination therapy given within 2 months after cryoablation is the most important risk factor for local refractory ulcer at puncture point.

Why This Matters

  • Patients should be switched to monotherapy in the 2 months after receiving cryoablation for relief of pain from superficial metastases.

  • If that's not an option, drug analgesia or other methods of relief should be used instead of cryoablation to achieve pain control.

Study Design

  • Investigators reviewed 36 patients who underwent local cryoablation for superficial HCC metastases of the chest wall, abdominal wall, rib, clavicle, and/or scapula.

Key Results

  • Six patients (17%) developed refractory thoracoabdominal wall ulcers within 2 months of the procedure.

  • Five of those patients were among the eight total (62.5%) who received combination therapy after the procedure.

  • Combined use of PD-1 antibodies and antiangiogenic TKIs within 2 months after cryoablation was the only significant risk factor for thoracoabdominal wall ulcer (odds ratio, 55.55; P = .010).

  • Because of the ulcer risk, the study investigators no longer perform cryoablation for patients receiving combined therapy.


  • The sample size was small.

  • Biopsy was not performed on the wounds to rule out ulcers caused by tumor.

  • It's unclear why the combination of therapies increases the risk of ulcers.


  • The work was funded by the National Natural Science Foundation of China.

  • The investigators disclosed no relevant financial relationships.

This is a summary of a preprint research study, "The Combined Use of PD-1 Antibodies and Anti-angiogenic TKIs Induces Intractable Thoracoabdominal Wall Ulcer in Patients Undergoing Cryoablation for Superficial Metastases of Hepatocellular Carcinoma," led by Shousheng Liu of Sun Yat-sen University Cancer Center, Guangzhou, China. The study has not been peer reviewed. The full text can be found at researchsquare.com.

M. Alexander Otto is a physician assistant with a master's degree in medical science and a journalism degree from Newhouse. He is an award-winning medical journalist who has worked for several major news outlets before joining Medscape and also an MIT Knight Science Journalism fellow. Email: aotto@mdedge.com.

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