Chen X, Liao H, Chen J, Peng LH, Zhang JH, Xuyun XX, Chen YJ, Chen T. Lenvatinib and pembrolizumab plus FOLFOX-hepatic arterial infusion chemotherapy in locally advanced, potentially resectable hepatocellular carcinoma. World J Gastrointest Oncol 2026; 18(7): 118522 [DOI: 10.4251/wjgo.v18.i7.118522]
Corresponding Author of This Article
Tao Chen, PhD, Department of Hepatobiliary Surgery, Sun Yat-sen Memorial Hospital, No. 107 Yanjiang West Road, Yuexiu District, Guangzhou 510120, Guangdong Province, China. ct0498@126.com
Research Domain of This Article
Oncology
Article-Type of This Article
research-article
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World J Gastrointest Oncol. Jul 15, 2026; 18(7): 118522 Published online Jul 15, 2026. doi: 10.4251/wjgo.v18.i7.118522
Lenvatinib and pembrolizumab plus FOLFOX-hepatic arterial infusion chemotherapy in locally advanced, potentially resectable hepatocellular carcinoma
Tao Chen, Ya-Jin Chen, Xiu-Xiu Xuyun, Ji-Hao Zhang, Lin-Hui Peng, Jie Chen, Hao Liao, Xi Chen
Xi Chen, Hao Liao, Jie Chen, Lin-Hui Peng, Ji-Hao Zhang, Xiu-Xiu Xuyun, Ya-Jin Chen, Tao Chen, Department of Hepatobiliary Surgery, Sun Yat-sen Memorial Hospital, Guangzhou 510120, Guangdong Province, China
Tao Chen, Key Laboratory of Malignant Tumor Gene Regulation and Target Therapy of Guangdong Higher Education Institutes, Department of Hepato-Pancreato-Billiary Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, Guangdong Province, China
Co-first authors: Xi Chen and Hao Liao.
Author contributions: Chen X and Liao H wrote the manuscript as co-first authors; Chen J and Peng LH prepared all figures; Zhang JH and Xuyun XX analyzed and interpreted the data; Chen YJ and Chen T designed the methodology; all authors read and approved the final version of the manuscript.
Supported by Guangdong Basic and Applied Basic Research Foundation Project, No. 2024A1515220164.
Institutional review board statement: The study studies involving human participants were reviewed and approved by the Ethics Committee of Sun Yat-sen Memorial Hospital (No. SYSKY-2024-660-01) and conducted with Declaration of Helsinki.
Informed consent statement: The informed consent to participate was waived by the Ethics Committee of Sun Yat-sen Memorial Hospital (SYSKY-2024-660-01).
Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.
Data sharing statement: Not applicable.
Corresponding author: Tao Chen, PhD, Department of Hepatobiliary Surgery, Sun Yat-sen Memorial Hospital, No. 107 Yanjiang West Road, Yuexiu District, Guangzhou 510120, Guangdong Province, China. ct0498@126.com
Received: January 5, 2026 Revised: February 4, 2026 Accepted: March 25, 2026 Published online: July 15, 2026 Processing time: 182 Days and 17.1 Hours
Abstract
BACKGROUND
Systemic therapies have improved management of hepatocellular carcinoma (HCC); however, further improvements in overall survival for first-line treatment of primary unresectable HCC remain necessary.
AIM
To evaluate the safety and efficacy of hepatic arterial infusion chemotherapy combined with lenvatinib and pembrolizumab for treating primary unresectable HCC.
METHODS
This retrospective study analyzed data from 38 patients who received this triplet therapy at Sun Yat-sen Memorial Hospital between December 2019 and March 2022.
RESULTS
The overall response rate was 50.0% (Response Evaluation Criteria in Solid Tumors criteria) and 52.6% (modified Response Evaluation Criteria in Solid Tumors criteria), with a disease control rate of 97.4%. The successful conversion rate, defined as meeting all prespecified criteria for surgical resectability was 50.0%. Consequently, the surgical conversion rate, reflecting the proportion of patients who underwent subsequent radical resection, was 44.7%. The pathological complete response rate was 7.9%. Grade III/IV treatment-related adverse events occurred in 10.53% of patients, with no perioperative deaths or major complications. The successful conversion group demonstrated significantly higher 1-year, 2-year, and 3-year survival rates compared to the unsuccessful conversion group.
CONCLUSION
Combination of hepatic arterial infusion chemotherapy, lenvatinib, and pembrolizumab is a promising and well-tolerated treatment strategy for primary unresectable HCC.
Core Tip: This retrospective study of 38 patients with initially unresectable hepatocellular carcinoma treated with hepatic arterial infusion chemotherapy, lenvatinib and pembrolizumab showed promising results. The overall response rate was 50.0%-52.6% with a disease control rate of 97.4%. The conversion to surgery rate was 44.7%, with a pathological complete response rate of 7.9%. Treatment was well-tolerated, with only 10.5% experiencing grade III/IV adverse events. Patients achieving successful conversion had significantly better long-term survival.
