ArticleFrontiers in immunology2026
Retrospective analysis of transarterial chemoembolization or hepatic arterial infusion chemotherapy combined with lenvatinib with or without PD-1 inhibitor as first-line therapy for unresectable hepatocellular carcinoma with high tumor burden: a propensity score-matched study.
Article in Frontiers in immunology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Purpose: To compare the efficacy, safety, and hepatic impact of TACE or HAIC plus lenvatinib with or without PD-1 inhibitors in unresectable hepatocellular carcinoma with high tumor burden (HTB-uHCC). Patients and methods: This retrospective study (2019-2023) included 278 HTB-uHCC patients (defined as tumors exceeding the up-to-11 criteria or exhibiting Vp4 portal vein tumor thrombus) receiving either doublet therapy (TACE or HAIC + lenvatinib, THL) or triplet therapy (TACE or HAIC + lenvatinib + PD-1 inhibitor, THLP) (139 per cohort after 1:1 propensity score matching; caliper=0.2). Primary endpoints included overall survival (OS) and progression-free survival (PFS). Secondary endpoints comprised objective response rate (ORR), serial liver function tests, and adverse events (AEs). Results: The THLP group demonstrated superior OS (median22.4 vs. 17.6 months, HR = 0.55, P < 0.001), PFS (13.5 vs. 8.5 months, HR = 0.53, P < 0.001), and ORR (72.7% vs. 52.5%, P < 0.001) compared to the THL group. No intergroup differences in albumin-bilirubin (ALBI) scores were observed at baseline or during months 1-5 (all P > 0.05). Both cohorts showed significant ALBI deterioration at progression versus baseline (P < 0.001). Child-Pugh stability at 6 months independently predicted ORR (adjusted OR 8.71, 95% CI 4.93-15.40; P <0.001). Grade 3-4 AEs occurred at comparable rates (46.8%vs. 43.2%,P=0.629), with no treatment-related deaths. Conclusion: Triplet therapy significantly improves survival and tumor response without accelerating early liver function decline in patients with HTB-uHCC. Child-Pugh stability correlates strongly with treatment efficacy.
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