Combination therapy reduces transarterial chemoembolization resistance in advanced hepatocellular carcinoma.

Background: Transarterial chemoembolization (TACE) is a main treatment for advanced hepatocellular carcinoma (HCC), but tumors often become resistant. Combining TACE programmed cell death (ligand) 1 [PD-(L)1] inhibitors and molecular targeted therapies (MTT) may improve outcomes, but its role in preventing TACE resistance requires further investigation.

Aim: To compare if TACE plus PD-(L)1 inhibitors and MTT reduces TACE resistance and improves survival in advanced HCC compared to TACE alone.

Methods: We analyzed 721 patients: 532 received TACE only, and 72 received TACE with PD-(L)1 inhibitors and MTT. After matching patient characteristics, 144 patients (72 pairs) were compared. Tumor progression after 3 treatment cycles was measured.

Results: The combination group exhibited significantly lower TACE resistance rates compared to the monotherapy group (9.7% vs 38.8%, P < 0.001). Moreover, patients in the combination group experienced prolonged progression-free survival (progression-free survival: 17.5 months vs 9.1 months, P = 0.004) and overall survival (overall survival: 20.8 months vs 16.4 months, P = 0.008). These findings underscore the efficacy of combination therapy in enhancing therapeutic outcomes in advanced HCC.

Conclusion: Adding immunotherapy and targeted drugs to TACE significantly reduces treatment resistance and improves survival in advanced liver cancer, suggesting it may become a new standard treatment.