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Background <p>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).</p> Methods <p>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.</p> Results <p>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%, <i>P</i> = 0.004) and overall disease control (90.2% vs. 69.4%, <i>P</i> = 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 (<i>P</i> = 0.0050) and a median overall survival of 20.0 months versus 17.0 months (<i>P</i> = 0.0038).</p> <p>TRAEs of any grade and grade 3–4 were similar between the two groups (<i>P</i> &gt; 0.05). No grade 5 TRAEs or treatment-related death were observed in either group.</p> Conclusions <p>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.</p>

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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

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  • 发表日期：

    2026年7月6日

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  • Jiayan Ni,
  • Hongliang Sun,
  • Chengzhi Li,
  • Yulong Liu,
  • Gefan Guo,
  • Xiong Zhou,
  • Zhiyong Zhou,
  • Rui Fan,
  • Hao Hu,
  • Zhuting Fang,
  • Linfeng Xu

摘要

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.