Drug-eluting bead TACE improves the efficacy of HAIC combined with molecular-targeted therapy and anti-PD-1 immunotherapy in large hepatocellular carcinoma with inferior vena cava and/or right atrium tumor thrombus: a multicenter retrospective cohort study.

BACKGROUND: To evaluate the safety and efficacy of combining hepatic arterial infusion chemotherapy (HAIC), molecular-targeted therapy (MTT), and programmed cell death 1 inhibitors (PD-1i) (HAIC-MTT-PD-1i) with or without drug-eluting bead transarterial chemoembolization (dTACE) (dTACE-HAIC-MTT-PD-1i) in large hepatocellular carcinoma (HCC) with tumor thrombus (TT) in the inferior vena cava (IVC) and/or right atrium (RA) (HCC-IVC/RA TT).

METHODS: We conducted a multicenter study of patients with large HCC-IVC/RA TT undergoing HAIC-MTT-PD-1i (HMP group) or dTACE-HAIC-MTT-PD-1i (THMP group) between January 01, 2021 and December 31, 2024. Local tumor responses, survival outcomes, and treatment-related adverse events (TRAEs) were analyzed between the two groups.

RESULTS: A total of 113 patients were enrolled, with 62 in the HMP group and 51 in the THMP group. The rates of overall objective response (76.5% vs. 50.0%, P = 0.004) and overall disease control (90.2% vs. 69.4%, P = 0.007) were significantly higher in the THMP group compared to the HMP group. The THMP group achieved a significantly superior median progression-free survival of 11.5 months compared to 8.0 months for the HMP group (P = 0.0050) and a median overall survival of 20.0 months versus 17.0 months (P = 0.0038). TRAEs of any grade and grade 3-4 were similar between the two groups (P > 0.05). No grade 5 TRAEs or treatment-related death were observed in either group.

CONCLUSIONS: dTACE-HAIC-MTT-PD-1i significantly improved efficacy compared to HAIC-MTT-PD-1i, while maintaining an acceptable safety profile for patients with large HCC-IVC/RA TT. Further RCTs are required to validate the findings.