Baokun Liu,1,2,* Lujun Shen,3,4,* Wen Liu,5 Zhiyong Zhang,1,2 Jieqiong Lei,1,2 Zhengguo Li,1,2 Qinquan Tan,6 Hengfei Huang,7 Xingdong Wang,1,2 Weijun Fan3,4 

1Department of Minimally Invasive Interventional Therapy, Sun Yat-Sen University Cancer Center Gansu Hospital, Lanzhou, 730050, People’s Republic of China; 2Department of Minimally Invasive Interventional Therapy, Gansu Provincial Cancer Hospital, Lanzhou, 730050, People’s Republic of China; 3Department of Minimally Invasive Interventional Therapy, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People’s Republic of China; 4State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People’s Republic of China; 5Department of Radiotherapy, Lanzhou University Second Hospital, Lanzhou, 730030,People’s Republic of China; 6Department of Oncology, Dongguan People’s Hospital, Dongguan, 523000, People’s Republic of China; 7Department of General Surgery, Chongzuo People’s Hospital, Chongzuo, 523000, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Xingdong Wang; Weijun Fan, Email wxd101027@163.com; fanwj@sysucc.org.cn

Purpose: The majority of new diagnoses of hepatocellular carcinoma (HCC) still pertain to unresectable cases. Currently, the combination therapy of tyrosine kinase inhibitors (TKIs) and programmed cell death protein-1 (PD-1) inhibitors has become the mainstream treatment. According to multiple clinical guidelines, it is strongly advised to consider local therapy as the primary treatment choice for uHCC. This research was conducted to examine the safety and effectiveness of combining hepatic arterial infusion chemotherapy (HAIC) with TKIs and PD-1 inhibitors for the treatment of uHCC.
Methods: Between 2015 and 2020, 208 HCC patients received HAIC alone or HAIC in combination with TKIs and PD-1 inhibitors. The overall survival(OS), and progression-free survival(PFS) and the best treatment response were compared between the two treatment groups. Propensity score matching (PSM)was used to minimize confounding bias.
Results: Among the enrolled patients, 116 patients (55.8%) received combination therapy, while 92 patients (44.2%) received HAIC alone. The baseline characteristics were similar between the two groups. After PSM, 82 pairs of well-matched liver cancer patients were selected; the overall response rate in the combination group trended better than that in the HAIC alone group. The hazard ratios (HRs) for OS and PFS of the combination approach compared to the HAIC-alone approach were 0.47 (95% CI, 0.322– 0.687; p< 0.001) and 0.58 (95% CI, 0.397– 0.848; p=0.005), respectively.
Conclusion: For uHCC patients, combination therapy can provide better OS and PFS compared to HAIC alone.

Keywords: hepatocellular carcinoma, TKIs, PD-1, HAIC, combination therapy