Hepatectomy is considered advisable for some patients with intermediate or advanced hepatocellular carcinoma (HCC). The efficacy and safety of neoadjuvant transarterial chemoembolization with tyrosine kinase and immune checkpoint inhibitors (neoadjuvant triple therapy) for these patients remain unclear. 583 patients who met the resectable criteria and were assigned to receive neoadjuvant triple therapy (n = 205) or direct hepatectomy (n = 378) at 20 Chinese medical centers (2019–2023) were retrospectively compared in terms of overall survival (OS), event-free survival (EFS), adverse events, and postoperative complications. The subgroup stratified includes 106 patients who underwent neoadjuvant triple therapy followed by hepatectomy or 99 patients who received it without subsequent hepatectomy. Compared to patients who undergo direct hepatectomy, those who receive neoadjuvant triple therapy show significantly higher OS (hazard ratio HR 0.70, 95%CI 0.53–0.92) and significantly longer median EFS (19.7 vs 10.9 months). Similar results are obtained after propensity score matching (PSM). Among patients who undergo hepatectomy, those with prior neoadjuvant triple therapy have significantly better OS (HR 0.45, 95%CI 0.31–0.66) and EFS (HR 0.49, 95%CI 0.38–0.63) than those with direct hepatectomy. Similar results are obtained after PSM. Among patients who receive neoadjuvant triple therapy, OS is significantly better among those who subsequently underwent hepatectomy (HR 0.40, 95%CI 0.24-0.67). neoadjuvant triple therapy results in a complete pathologic response rate of 34.0%. However, the regimen is associated with high rates of serious adverse events and postoperative complications, including hepatic insufficiency, bile leakage, and ascites. Neoadjuvant triple therapy offers OS and EFS benefits for patients with resectable intermediate or advanced HCC, but is associated with an increased risk of adverse events and postoperative complications. Yang et al. compare neoadjuvant triple therapy versus direct hepatectomy in patients with resectable intermediate or advanced hepatocellular carcinoma. The findings indicate that the neoadjuvant regimen improves overall and event-free survival but is associated with a higher risk of serious adverse events and postoperative complications. Intermediate- or advanced-stage hepatocellular carcinoma (HCC) is a cancer of the liver in which multiple tumors are present. People with HCC have a poor prognosis. One treatment is the delivery of chemotherapy directly to the tumor whilst blocking the blood supply to the tumor (transarterial chemoembolization) combined with other anti-cancer drugs (tyrosine kinase inhibitors and immune checkpoint inhibitors) prior to surgery to remove the cancer. This treatment, termed neoadjuvant triple therapy, followed by the surgery gives improved survival compared to surgery prior to treatment with drugs. However, this treatment is also associated with a higher incidence of severe postoperative complications. These findings suggest that neoadjuvant triple therapy may represent a viable treatment option for some people with intermediate- or advanced-stage HCC, but its application requires careful consideration of the survival benefits relative to the risks of treatment-related adverse events and death.
Yang et al. (Thu,) studied this question.