Efficacy and Safety of TACE Combined with Lenvatinib and PD-(L)1 Inhibitor in the Treatment of Unresectable Hepatocellular Carcinoma: A Retrospective Study

Purpose: In the study, patients with unresectable hepatocellular carcinoma (uHCC) were treated with either transcatheter chemoembolization (TACE) combined with lenvatinib and PD-(L)1 inhibitor (TACE-L-P) or TACE combined with lenvatinib (TACE-L). We compared the efficacy and safety of TACE-L-P with TACE-L, and analyzed factors affecting prognosis.Materials and Methods: A total of 122 patients were treated with either TACE-L-P (n = 64) or TACE-L (n = 58), and their data was collected and analyzed. We assessed tumor response, progression-free survival (PFS), prognostic factors for PFS and adverse events (AEs) to compare the efficacy and safety of TACE-L-P with TACE-L for patients with uHCC.Results: TACE-L-P group's patients had a better objective response rate (ORR) (57.8% vs 41.4%, P = 0.047) and a better disease control rate (93.7% vs 81%, P = 0.013), as long as a longer median progression-free survival (PFS) (8 months vs 4.6 months, HR: 0.461; 95% CI: [0.314-0.675]; P = 0.001) than TACE-L group's patients. According to multivariate analysis, independent prognostic factors for PFS included treatment option (TACE-L-P / TACE-L; RH = 0.461; 95% CI [0.314-0.675]; P = 0.001), PVTT (Yes/No; RH =1 0.599;95% CI [1 0.095-2 0.336]; P=0 0.017), extrahepatic metastasis (Yes/No; RH=1 0.847;95% CI [1 0.176 -2 0.909]; P=0 0.008). AEs in TACE-L-P group was similar with TACE-L group.Conclusion: TACE-L-P has more promising clinical outcomes in patients with uHCC than TACE-L, and their safety is similar.