Transcatheter arterial chemoembolization combined with immune checkpoint inhibitors plus bevacizumab or lenvatinib in hepatocellular carcinoma: Results from a retrospective dual-center cohort study.

e16159 Background: Hepatocellular carcinoma (HCC) ranks as the sixth most prevalent cancer worldwide. Notably, over 80% of HCC cases are diagnosed at an intermediate to advanced stage. Transcatheter arterial chemoembolization (TACE) is globally acknowledged as the standard local treatment for intermediate HCC and remains the predominant care for advanced HCC, While lenvatinib (LEN) or the combination of bevacizumab (BEV) and atezolizumab is recognized as a first-line systemic therapy for HCC. Moreover, TACE+LEN+immune checkpoint inhibitors (ICIs) in the treatment of HCC significantly enhances OS and PFS compared to the TACE+LEN. However, comparative studies between TACE+ICI+BEV and TACE+ICI+LEN are still forthcoming. Methods: This retrospective study encompasses data from 64 patients diagnosed with intermediate to advanced unresectable HCC at two medical centers in China between January 2021 and June 2023. The study's primary outcomes were overall survival (OS) and progression-free survival (PFS), while secondary outcomes included tumor response and conversion rates. Additionally, the study assessed the safety by adverse events (AE) across the two groups. Results: Of the 64 enrolled patients, 31 were treated with TACE+ICI+BEV and 33 with TACE+ICI+LEN. There was no significant difference in PFS between the two groups (5.7 months 95% confidence interval (CI) 5.2 to 7.9 versus 4.9 months 95% CI 4.5 to 7.7, P=0.404). The median OS for the TACE+ICI+LEN group was 21.3 months (95% CI 15.1 to 27.5), whereas the median OS in TACE+ICI+BEV group was not reached. A markedly higher proportion of patients in the TACE+ICI+BEV group achieved surgical conversion (22.6% versus 3.0%, P=0.047). Patients presenting with an alanine aminotransferase (ALT) level ≤40 u/L (hazard ratio HR=5.61, 95% CI 1.09-28.80, P=0.039) and without hepatic vein invasion (HR=31.6, 95% CI 1.03-9.68, P=0.044) appeared to derive greater benefit from the TACE+ICI+BEV regimen. Furthermore, patients with a Child-Pugh score of class A exhibited enhanced response to the triple-combination therapy (HR=6.17, 95% CI 1.86-20.53, P=0.003). Both therapeutic strategies were characterized by favorable safety profiles. Conclusions: TACE+ICI+BEV has demonstrated notable potential in increasing surgical conversion rate in the management of intermediate to advanced HCC, suggesting enhanced outcomes particularly in patients with superior liver function. Table: see text