A study on the safety and effectiveness of transcatheter arterial chemoembolization and bevacizumab arterial infusion combined comprehensive treatment for hepatocellular carcinoma

To evaluate the safety and efficacy of transcatheter arterial chemoembolization (TACE) combined with intra-arterial bevacizumab infusion in patients with advanced hepatocellular carcinoma (HCC). In this prospective randomized controlled trial, 120 patients with advanced HCC (stages Ib-IIIb) were enrolled between March 2021 and October 2023 and randomized to receive TACE alone (control group, n=60) or TACE plus intra-arterial bevacizumab (combined group, n=60). Tumor perfusion parameters were assessed via dynamic contrast-enhanced MRI (DCE-MRI), while VEGF and SDF-1 levels were measured using ELISA. Efficacy, safety, and adverse events were compared between groups. Efficacy analyses for tumor response were based on 58 patients per group with complete imaging data. The combined group exhibited significant reductions in DCE-MRI parameters, including transfer coefficient, blood flow, and plasma volume (all P<0.05). Complete response (CR) rates were 0% in both groups (P>0.05). Partial response (PR) rates were higher in the combined group (27.6% vs. 6.9%, P<0.05), as were stable disease (SD) rates (60.3% vs. 34.5%, P<0.05). Total disease control (CR+PR+SD) was significantly improved in the combined group (87.9% vs. 41.4%, P<0.05). Liver/kidney function and adverse event rates (e.g., hypertension, 8.3% in combined group) were comparable between groups (P>0.05), though proteinuria was more frequent in the combined group (6.7% vs. 0%, P=0.043). Intra-arterial bevacizumab combined with TACE enhances tumor response and disease control in advanced HCC without a substantial increase in overall toxicity, providing a promising locoregional anti-angiogenic strategy.