Enhanced Efficacy of TACE Combined with TKIs and ICIs in Treating HCC

A recent meta-analysis and trial sequential analysis (TSA) have highlighted the benefits of combining transarterial chemoembolization (TACE) with tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs) for the treatment of hepatocellular carcinoma (HCC). This study compared the therapeutic efficacy and adverse events (AEs) between TACE plus TKIs and ICIs (TACE + T + I) versus TACE plus TKIs alone (TACE + T) in patients with BCLC intermediate- or advanced-stage HCC.

Key Findings:

• Objective Response Rate (ORR): The combination of TACE + T + I significantly improved the ORR (risk ratio [RR] = 1.53, 95% confidence interval [CI] = 1.27-1.85, p < 0.01) compared to TACE + T.
• Progression-Free Survival (PFS): Patients treated with TACE + T + I experienced a longer median PFS (mean difference [MD] = 4.51 months, 95% CI = 2.16-6.87, p < 0.01).
• Overall Survival (OS): The median OS was also extended in the TACE + T + I group (MD = 5.75 months, 95% CI = 4.03-7.48, p < 0.01).
• Adverse Events (AEs): Hypertension was more common in the TACE + T + I group (RR = 1.58, 95% CI = 1.05-2.40, p < 0.05), though further studies are needed to confirm this finding. No significant differences were observed in other AEs between the two groups.

The TSA confirmed these results without the need for a larger information size, suggesting that the combination of TACE with TKIs and ICIs offers a promising treatment strategy for HCC patients, despite the increased risk of hypertension.