Effectiveness of transarterial chemoembolization in combination with lenvatinib and programmed cell death protein-1 inhibition for unresectable hepatocellular carcinoma

Abstract

This editorial comments on the study by Ma et al, which delves into the efficacy and predictive factors associated with the combination of transarterial chemoembolization, lenvatinib, and programmed cell death protein-1 inhibition for the management of unresectable hepatocellular carcinoma. Analysing data from a retrospective study involving 102 patients, the treatment showcased a median overall survival (OS) of 26.43 months and a median progression-free survival (PFS) of 10.07 months. Notably, the objective response rate and disease control rate reached 61.76% and 81.37%, respectively. Specific factors such as Barcelona Clinic Liver Cancer (BCLC) Classification B-stage, early neutrophil-to-lymphocyte ratio response, and early alpha-fetoprotein response (> 20% decrease) correlated with superior OS and PFS. The triple therapy exhibited promising efficacy, particularly in BCLC B-stage disease, with prognostic markers aiding in patient stratification. Acknowledging the retrospective nature of the study design, future research should address this limitation and incorporate longer follow-up periods for a comprehensive evaluation of long-term outcomes.

Keywords: Hepatocellular carcinoma; Transarterial chemoembolization; Lenvatinib; Programmed cell death protein-1 inhibitors; Unresectable hepatocellular carcinoma

Core Tip: Transarterial chemoembolization (TACE) combined with lenvatinib and programmed cell death protein-1 (PD-1) inhibitors presents an encouraging therapeutic approach for unresectable hepatocellular carcinoma (HCC). This triple therapy demonstrates well-tolerated outcomes with a median overall survival of 26.43 months and a median progression-free survival of 10.07 months. Notably, patients with Barcelona Clinic Liver Cancer B-stage, exhibiting early neutrophil-to-lymphocyte ratio and alpha-fetoprotein responses, show superior clinical outcomes. Understanding these predictive factors can guide treatment decisions and enhance the efficacy of TACE/lenvatinib/PD-1 therapy in unresectable HCC.