719P Tyrosine kinase inhibitors and/or immune checkpoint inhibitors is required for improving efficacy of transarterial chemoembolization for hepatocellular carcinoma: A large-scale multicenter real-world study of 582 patients

Data on elucidating the efficacy and safety of transarterial chemoembolization (TACE) based systemic therapy in patients with hepatocellular carcinoma (HCC) are lacking. In this multicenter retrospective study, 582 HCC patients receiving TACE based therapy were enrolled between Apr 2015 and Dec 2021. Patients were assigned either with TACE monotherapy (n=317), TACE plus tyrosine kinase inhibitors (TKIs) (n=66), TACE plus immune checkpoint inhibitors (ICIs) (n=33), or TACE plus TKIs and ICIs (n=139). The efficacy and safety of four treatment regimens were compared. There were no significant differences among the four study groups in baseline characteristics, including BCLC stage, tumor number, tumor size and embolus (all P>0.05). The mean follow-up period was 17.6 (95% CI: 15.7-19.5) months and the mean number of TACE sessions were 3 (range 1-13) for all patients. The objective response rate (ORR) was 28.7%, 39.4%, 42.4%, and 57.6%, respectively (P=0.024), while the disease control rate (DCR) was 54.6%, 72.7%, 69.7%, and 87.1%, respectively (P=0.037) (mRECIST). The TACE plus TKIs and ICIs group achieved the longest median progression-free survival (PFS) and overall survival (OS) compared to the other 3 groups, especially to the TACE alone group (PFS: 6.4 vs. 7.1 vs. 7.3 vs. 8.7 months, P=0.046; and OS: 15.1 vs. 17.6 vs. 18.5 vs. 21.9 months, P=0.030). There were no unexpected toxicities. TACE plus TKIs and ICIs appeared to deliver the longest PFS and OS in HCC patients receiving TACE based regimens. Adverse events were consistent with those of previous TACE combination trials.