# Efficacy and safety of TACE-HAIC combined with tyrosine kinase inhibitors and immune checkpoint inhibitors for the patients with BCLC-defined stage B-C HCC

## TL;DR

This study shows that combining TACE, HAIC, TKIs, and ICIs improves survival for patients with intermediate-to-advanced liver cancer, though it increases side effects.

## Contribution

The study introduces a novel combination therapy for hepatocellular carcinoma that includes TACE, HAIC, TKIs, and ICIs, showing improved survival outcomes.

## Key findings

- The T+H+T+I group had significantly better overall survival (20.77 months) compared to the H+T+I group (14.23 months).
- The T+H+T+I regimen achieved a 54% objective response rate and 76% disease control rate.
- The combination therapy showed increased toxicity, with 28% of patients experiencing grade ≥3 adverse events.

## Abstract

To evaluate the therapeutic efficacy and safety profile of combining transarterial chemoembolization (TACE) with hepatic arterial infusion chemotherapy (HAIC) combined with tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs) in patients with hepatocellular carcinoma (HCC) classified as Barcelona Clinic Liver Cancer (BCLC) stage B or C.

This single-center retrospective analysis included patients with intermediate-to-advanced HCC diagnosed and treated between January 2020 and December 2023. Of 197 eligible patients meeting inclusion criteria, 103 were allocated to the TACE+HAIC+TKI+ICI (T+H+T+I) group and 94 to the HAIC+TKI+ICI (H+T+I) group. Propensity score matching (PSM) was employed to minimize confounding bias, yielding 50 patients per group in the final matched cohorts. Comparative analyses assessed overall survival (OS), progression-free survival (PFS), objective response rate (ORR), and disease control rate (DCR). Primary endpoints were OS and PFS; secondary endpoints included ORR and safety outcomes.

Among the 100 patients included in the analysis, 50 patients received T+H+T+I therapy while the remaining 50 underwent H+T+I treatment, with median follow-up durations of 13.1 months and 14.3 months, respectively. After PSM, the baseline characteristics showed no significant differences between the two groups. The T+H+T+I group demonstrated superior median overall survival (mOS) (20.77 months [95% CI: 11.37-30.16] vs 14.23 months [95% CI: 12.23-16.24]; P=0.019) and longer median progression-free survival (mPFS) (15.43 months [95% CI: 11.85-19.02] vs 10.60 months [95% CI: 7.71-13.49]; P<0.001) as assessed by modified Response Evaluation Criteria in Solid Tumors (mRECIST) version 1.1. The T+H+T+I regimen exhibited superior tumor control outcomes, with an ORR of 54% and DCR of 76%. However, this group also showed increased toxicity profiles, with 14 patients (28%) experiencing grade ≥3 adverse events.

For patients with BCLC stage B-C HCC, the T+H+T+I combination therapy demonstrated superior survival benefits, particularly in those with tumor diameter ≥5 cm and presence of portal vein tumor thrombosis (PVTT), while maintaining an acceptable safety profile.