Efficacy analysis of hepatic arterial infusion chemotherapy combined with sintilimab and bevacizumab for initially unresectable hepatocellular carcinoma.

Background and aims: Hepatocellular carcinoma (HCC) presents a significant challenge in tumor management because of its low resection rates. Conversion therapy aims to transform unresectable tumors into resectable ones through local treatments, thereby providing surgical options for some patients with HCC. However, the overall strategies and efficacy of conversion therapy for HCC remain inadequately defined. This study was performed to evaluate the efficacy of hepatic arterial infusion chemotherapy (HAIC) combined with sintilimab and bevacizumab in patients with unresectable liver cancer. Methods: We conducted a retrospective analysis of patients with initially unresectable HCC who received HAIC in conjunction with sintilimab and bevacizumab. Preoperative demographic data, tumor markers, tumor size, tumor count, conversion outcomes, and surgery-related clinical data were collected and analyzed before and after treatment. Results: Twelve patients were included in this study. All patients exhibited satisfactory antitumor effects. Ten patients underwent one or two treatment cycles, while two completed four cycles. The mean alpha-fetoprotein level decreased from 73,471 ± 138,239 to 2374 ± 6325 ng/mL, and the mean tumor size decreased from 11.4 ± 2.2 to 7.6 ± 1.0 cm. Following evaluation, 10 patients were successfully converted, with 6 ultimately undergoing curative liver cancer resection; of these 6 patients, 4 achieved a pathological complete response. Conclusion: The combination of HAIC with sintilimab and bevacizumab represents a safe and effective strategy for tumor conversion. This approach can achieve significant tumor reduction and favorable effects on portal vein tumor thrombus within a short timeframe, facilitating curative resection of liver cancer.