What does this research mean for the field?

The combination of hepatic arterial infusion chemotherapy with apatinib and camrelizumab significantly improves overall survival and progression-free survival in advanced hepatocellular carcinoma patients with type Vp4 portal vein tumor thrombosis compared to hepatic arterial infusion chemotherapy alone. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

What question did this study set out to answer?

To assess the efficacy of hepatic arterial infusion chemotherapy combined with apatinib and camrelizumab for advanced HCC with portal vein tumor thrombosis.

February 20, 2026Open Access

Hepatic arterial infusion chemotherapy combined with apatinib plus camrelizumab for advanced hepatocellular carcinoma with type Vp4 portal vein tumor thrombosis: a multicenter propensity score-matching analysis

Key Points

To assess the efficacy of hepatic arterial infusion chemotherapy combined with apatinib and camrelizumab for advanced HCC with portal vein tumor thrombosis.
Retrospective review of advanced HCC patients with type Vp4 portal vein invasion.
Patients received either HAIC combined with apatinib and camrelizumab or HAIC alone.
Propensity score matching to balance baseline differences between groups.
Comparison of overall survival, progression-free survival, objective response rate, and disease control rate between groups.
The HAICAC group showed median overall survival of 24.1 months compared to 7.2 months for HAIC alone (P<0.001).
Progression-free survival was 7.0 months for HAICAC versus 4.3 months for HAIC (P<0.001).
Objective response rate for intrahepatic lesions was 75.6% in HAICAC compared to 31.4% in HAIC (P<0.001).
For portal vein tumor thrombosis, the objective response rate was 60.5% in HAICAC versus 17.4% in HAIC (P<0.001).
Higher incidence of immune-related adverse events in HAICAC, but all were manageable.

Abstract

Background Portal vein main trunk invasion is a serious and difficult complication of hepatocellular carcinoma (HCC), with extremely poor prognosis and limited treatment options. The traditional standard sorafenib has a limited efficacy. The combination of hepatic arterial infusion chemotherapy (HAIC) with camrelizumab and apatinib has shown satisfactory efficacy in previously advanced HCC. Therefore, this approach has potential advantageous survival benefits for HCC with invasion of the portal vein main trunk. Methods A retrospective review was conducted on the clinical data of advanced HCC patients with type Vp4 portal vein invasion who received HAIC combined with apatinib and camrelizumab (HAICAC group) or HAIC alone (HAIC group) treatment in four medical centers from June 2016 to December 2023. Propensity score matching was employed to balance the baseline differences between the groups. The overall survival, progression-free survival, objective response rate and disease control rate were compared between the groups. Results Following PSM, the HAICAC regimen demonstrated significantly superior clinical outcomes, with median OS (24.1 versus 7.2 months) and PFS (7.0 versus 4.3 months) significantly exceeding those of HAIC monotherapy (all P0.001). The combination therapy also exhibited markedly improved tumor response rates, achieving superior objective response rates for both intrahepatic lesions (75.6% versus 31.4%, P0.001) and PVTT (60.5% versus 17.4%, P0.001). While the HAICAC group showed a higher incidence of immune-related adverse events compared to the HAIC group, all events were manageable and no grade 5 toxicities occurred. Conclusion For HCC with Vp4 type PVTT, the combination regimen of HAIC plus apatinib and camrelizumab demonstrates promising efficacy in reducing both intrahepatic tumor burden and thrombus progression, representing a potentially viable treatment approach with an acceptable safety profile.

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