Hepatic Arterial Infusion Chemotherapy Combined with Tyrosine Kinase Inhibitors and PD-1 Inhibitors in Hepatocellular Carcinoma

Abstract Purposes: To compare the efficacy and safety of hepatic arterial infusion chemotherapy (HAIC) combined with tyrosine kinase inhibitors (TKIs) and anti-programmed cell death protein-1 (PD-1) immunotherapy versus combination therapy of transarterial chemotherapy (TACE), TKIs and PD-1 inhibitors in the treatment for hepatocellular carcinoma (HCC). Methods: The data of 302 patients with HCC receiving HAIC combined with TKIs and PD-1 inhibitors (HAIC-TP group) and 446 patients receiving TACE combined with TKIs and PD-1 inhibitors (TACE-TP group) were retrospectively collected. The progression-free survival (PFS), overall survival (OS), tumor response and adverse events were compared between two groups. Propensity-score matching (PSM) analysis were utilized to minimize the bias. Results: HAIC-TP group exhibited longer PFS (17.1 months versus 8.9 months, P < 0.001), longer OS (not reached versus 14.3 months, P < 0.001) and better objective response rate (RECIST: 33.1% versus 7.8%, P < 0.001; mRECIST: 51.4% versus 17.5%, P < 0.001) than TACE-TP group. Nausea, diarrhea and abdominal pain were more frequent in the HAIC-TP group, while liver dysfunction occurred more common in the TACE-TP group. PSM analysis showed the same results. Conclusions: In patients with HCC, the combination of HAIC with TKIs and anti-PD-1 immunotherapy is an effective and safe therapeutic regimen over TACE-based combination therapy. A prospective study with a large sample size is needed to validate the efficacy and safety of the combination therapy.