Neoadjuvant transarterial chemoembolization with tyrosine kinase and immune checkpoint inhibitors improves survival...

Hepatectomy is considered advisable for some patients with intermediate or advanced hepatocellular carcinoma (HCC). The efficacy and safety of neoadjuvant transarterial chemoembolization with tyrosine kinase and immune checkpoint inhibitors (neoadjuvant triple therapy) for these patients remain unclear.

583 patients who met the resectable criteria and were assigned to receive neoadjuvant triple therapy (n = 205) or direct hepatectomy (n = 378) at 20 Chinese medical centers (2019-2023) were retrospectively compared in terms of overall survival (OS), event-free survival (EFS), adverse events, and postoperative complications. The subgroup stratified includes 106 patients who underwent neoadjuvant triple therapy followed by hepatectomy or 99 patients who received it without subsequent hepatectomy.

Compared to patients who undergo direct hepatectomy, those who receive neoadjuvant triple therapy show significantly higher OS (hazard ratio [HR] 0.70, 95%CI 0.53-0.92) and significantly longer median EFS (19.7 vs 10.9 months). Similar results are obtained after propensity score matching (PSM). Among patients who undergo hepatectomy, those with prior neoadjuvant triple therapy have significantly better OS (HR 0.45, 95%CI 0.31-0.66) and EFS (HR 0.49, 95%CI 0.38-0.63) than those with direct hepatectomy. Similar results are obtained after PSM. Among patients who receive neoadjuvant triple therapy, OS is significantly better among those who subsequently underwent hepatectomy (HR 0.40, 95%CI 0.24-0.67). neoadjuvant triple therapy results in a complete pathologic response rate of 34.0%. However, the regimen is associated with high rates of serious adverse events and postoperative complications, including hepatic insufficiency, bile leakage, and ascites.

Neoadjuvant triple therapy offers OS and EFS benefits for patients with resectable intermediate or advanced HCC, but is associated with an increased risk of adverse events and postoperative complications.