Pre-transplant downstaging strategies for hepatocellular carcinoma with portal vein tumor thrombus: Current therapies and future challenges

Table 2 Transarterial chemoembolization-based combination therapies for hepatocellular carcinoma with portal vein tumor thrombus

Ref.	Population	Treatment arms	ORR (%)	Median OS (months)	Median PFS (months)	Key findings
Yuan et al[5]	743 HCC with PVTT	TACE + HAIC + TKIs + PD-1 vs TACE	53.7 vs 7.8	Not reached vs 10.4	14.8 vs 2.3	Best surgical conversion and pCR outcomes
You et al[38]	265 HCC with PVTT	IT + TACE vs IT	–	19.0 vs 13.0	12.0 vs 7.3	TACE enhances immune-targeted response
Lu et al[39]	227 Vp2–Vp3 PVTT	TACE + PEI + Lenvatinib vs TACE + Lenvatinib	50.5 vs 25.8	17.1 vs 13.9	8.1 vs 6.5	PEI boosts PVTT regression
Lu et al[40]	105 Vp4 PVTT	125I stent + TACE vs Sorafenib + TACE	–	9.9 vs 6.3	6.6 vs 4.2	125I stent prolongs survival and patency
Zou et al[41]	165 HCC with PVTT	TACE + Lenvatinib + PD-1 vs TACE + Sorafenib + PD-1	41.3 vs 30.6	21.7 vs 15.6	6.3 vs 3.2	Lenvatinib triple better than Sorafenib triple
Lin et al[42]	95 PVTT + APFs	HAIC + Lenvatinib + PD-1 vs TACE + Lenvatinib + PD-1	52.9 vs 27.9	25.0 vs 19.3	21.7 vs 8.7	HAIC favored in APF setting
Zhao et al[43]	58 PVTT + APFs	TACE + 125I vs TACE + Sorafenib	–	12.8 vs 8.0	–	125I improves APF control and OS
Yang et al[44]	116 PVTT	TACE + Lenvatinib vs TACE + Sorafenib	66.8 vs 33.3	18.97 vs 10.77	10.6 vs 5.4	TACE-L significantly outperforms TACE-S in ORR, OS, and PFS

PFS: Progression-free survival; HCC: Hepatocellular carcinoma; TACE: Transarterial chemoembolization; TARE: Transarterial radioembolization; PVTT: Portal vein tumor thrombus; ORR: Objective response rate; OS: Overall survival; HAIC: Hepatic arterial infusion chemotherapy; APF: Atypical portal flow; PEI: Percutaneous ethanol injection; IT: Immunotherapy; TKI: Tyrosine kinase inhibitor.