Combined transarterial therapy, tyrosine kinase inhibitors, and immune checkpoint inhibitors in unresectable hepatocellular carcinoma

Abstract

Abstract Patients with unresectable hepatocellular carcinoma (uHCC) have poor long-term prognosis, necessitating alternative treatment modalities. We assessed the efficacy and safety of tyrosine kinase inhibitors and immune checkpoint inhibitors combined with either transarterial chemoembolisation, hepatic artery infusion chemotherapy, or combined transcatheter arterial embolisation and hepatic artery infusion chemotherapy in patients with uHCC. The efficacy, represented by survival and tumour response, and tolerability, represented by adverse event frequency and severity, of the treatments were retrospectively evaluated for 119 patients with uHCC. Eighty-three patients received triple therapy with tyrosine kinase inhibitors, immune checkpoint inhibitors, and either transarterial chemoembolisation or hepatic artery infusion chemotherapy, and 36 received quadruple therapy with tyrosine kinase inhibitors, immune checkpoint inhibitors, combined transcatheter arterial embolisation, and hepatic artery infusion chemotherapy. Patients who received quadruple therapy showed higher progression-free survival and overall survival than those who received triple therapy. The conversion rate to resectable hepatocellular carcinoma and the objective response rate of the quadruple therapy group was higher; however, the disease control rate showed no significant differences. The incidence and severity of adverse events were comparable between the quadruple and triple therapy groups. Quadruple therapy may improve survival prognosis compared with triple therapy without compromising safety in patients with uHCC.