Safety and efficacy of TACE combined with immune checkpoint inhibitors plus molecular targeted therapies in older adults with unresectable hepatocellular carcinoma.

Objectives: To assess the efficacy and tolerability of transarterial chemoembolization (TACE) plus immune checkpoint inhibitors (ICIs) plus molecular targeted therapies (MTT) in elderly patients with hepatocellular carcinoma (HCC) (≥ 65 years).

Methods: This retrospective, multicenter study enrolled treatment-naïve HCC patients undergoing TACE combined with ICIs and MTT at three Chinese medical centers from June 2019 to December 2023. The study's primary endpoint was overall survival (OS), with secondary endpoints being the objective response rate (ORR), disease control rate (DCR) per modified RECIST criteria, and adverse events (AEs). To minimize selection bias, propensity score matching (PSM) was utilized for the elderly and younger patient cohorts.

Results: The study cohort comprised 317 patients, with a median OS of 30.8 months for the overall population. The elderly patients had comparable OS (median, 33.3 vs. 30.4 months, P = 0.219) than younger patients. The PSM cohort included 106 elderly patients and 106 younger patients. After PSM, the elderly patients also had similar OS compared with younger patients (median, 33.3 vs. 24.6 months, P = 0.141). Meanwhile, the elderly patients achieved a similar ORR and DCR (58.5% vs. 54.7%, P = 0.579; 90.1% vs. 85.8%, P = 0.287, respectively) versus younger patients. No obvious differences in grade 3/4 AEs were noted among the two groups, and no new safety concerns arose.

Conclusions: Elderly patients (age ≥ 65 years) receiving TACE combined with ICIs and MTT showed similar trends in prognosis and safety profiles compared with younger patients.