Hepatocellular Carcinoma Management in the Era of Immunotherapy: Retrospective Pilot Study Based on Real-Life Experience Data in Unselected Patients

Introduction: Hepatocellular carcinoma (HCC) remains a major cause of cancer-related mortality, and many patients present with intermediate or advanced disease. Transarterial chemoembolization (TACE) is an established treatment; however, its proangiogenic effects support the use of combination therapy. Combinations of TACE with immune checkpoint inhibitors (ICIs) and tyrosine kinase inhibitors (TKIs) have shown a promising antitumor activity. The objective of this study was to describe post-treatment mRECIST response patterns of TACE alone, TACE plus lenvatinib and pembrolizumab, and TACE plus atezolizumab and bevacizumab for HCC. Methods: This multicentre retrospective, non-randomized pilot study included 25 consecutive patients with unresectable HCC treated with TACE alone (n = 10), TACE–lenvatinib–pembrolizumab (n = 7), or TACE–atezolizumab–bevacizumab (n = 8). The primary outcome was first post-treatment mRECIST response. ORR and DCR were calculated descriptively. Secondary outcomes included imaging interval, TACE exposure, repeat TACE, ALBI change, and OS, estimated using Kaplan–Meier methods. Results: Complete response, partial response, stable disease, and progressive disease occurred in 30.0%, 30.0%, 10.0%, and 30.0% after TACE alone, 14.3%, 28.6%, 57.1%, and 0% after TACE–lenvatinib–pembrolizumab, and 0%, 37.5%, 0%, and 62.5% after TACE–atezolizumab–bevacizumab. ORR/DCR were 60.0%/70.0%, 42.9%/100.0%, and 37.5%/37.5%, respectively. Median imaging intervals were 38.0, 25.0, and 20.0 months. ALBI-grade worsening occurred in 30.0%, 42.9%, and 37.5%; 1-year OS was 78.8%, 83.3%, and 50.0%, respectively. Conclusions: mRECIST response patterns were heterogeneous. Baseline liver-function imbalance, small groups, and non-randomized allocation preclude comparative efficacy inference. Larger prospective studies should standardize treatment sequencing, imaging, liver function assessment, safety monitoring, and survival evaluation.