What question did this study set out to answer?

To analyze the landscape of clinical trials using immune checkpoint inhibitors for hepatocellular carcinoma worldwide. This includes assessing geographic distribution, targets, and publication rates.

June 14, 2026Open Access

Application of immune checkpoint inhibitors in hepatocellular carcinoma: a landscape analysis of clinical trial databases

Key Points

To analyze the landscape of clinical trials using immune checkpoint inhibitors for hepatocellular carcinoma worldwide. This includes assessing geographic distribution, targets, and publication rates.
Systematic search of four clinical trial databases until February 2026
Analysis included 132 eligible trials focusing on geographic distribution, molecular targets, clinical phases, and publication status
Utilized R 4.5.1 for data analysis
Trials showed a significant geographic concentration with 95 in China and 16 in the US
PD-1/PD-L1 inhibitors were the most common, while CTLA-4 trials were scarce
Only 6 trials were terminated or withdrawn, indicating a low overall result publication rate, with over 71% of CTLA-4 trials unpublished

Abstract

Background Hepatocellular carcinoma (HCC) is a leading global malignant tumor with poor prognosis. Immune checkpoint inhibitors (ICIs) have become a breakthrough treatment for HCC, but a systematic landscape analysis of global ICI clinical trials is lacking. Methods Four international clinical trial databases were systematically searched up to February 14, 2026. After screening, 132 eligible trials were included and analyzed for geographic distribution, molecular targets, clinical phases, trial status and result publication rate using R 4.5.1. Results Trials displayed a China–US dual-core pattern (95 vs. 16). PD-1/PD-L1 inhibitors were the predominant targets, while CTLA-4 inhibitor trials were scarce. Phase II was the most frequent clinical phase (59 trials). Over 80% were interventional studies; most were recruiting or of unknown status, with only 6 terminated or withdrawn. The overall result publication rate was extremely low, with 71 PD1-targeting trials and 71.4% CTLA-4 trials were unpublished. Conclusion Global HCC ICIs trials are highly concentrated geographically and by target, with stable research progress. However, major challenges include low result translation efficiency, unbalanced target development, insufficient early/late-phase trials and uneven global collaboration. Targeted optimization is needed to promote clinical translation.

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