Jiao HY, Yan XM, Li JX, Zhang ZG. Combination therapy reduces transarterial chemoembolization resistance in advanced hepatocellular carcinoma. World J Clin Oncol 2025; 16(8): 109419 [DOI: 10.5306/wjco.v16.i8.109419]
Corresponding Author of This Article
Zhen-Gang Zhang, MD, PhD, Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Avenue, Wuhan 430000, Hubei Province, China. zgzhang@tjh.tjmu.edu.cn
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Hu-Yu Jiao, Xin-Mei Yan, Jun-Xin Li, Zhen-Gang Zhang, Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, Hubei Province, China
Author contributions: Jiao HY, Yan XM, and Li JX designed the study, collected and analyzed the data, and drafted the manuscript; Zhang ZG designed and revised the manuscript; and all authors thoroughly reviewed and endorsed the final manuscript.
Institutional review board statement: This study was approved by the Medical Ethics Committee of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, approval No. TJ-IRB202412142.
Informed consent statement: This study only analyzed the data and was exempted from informed consent from the patients.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The datasets used and analyzed in the current study are available from the corresponding author on reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zhen-Gang Zhang, MD, PhD, Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Avenue, Wuhan 430000, Hubei Province, China. zgzhang@tjh.tjmu.edu.cn
Received: May 12, 2025 Revised: May 25, 2025 Accepted: July 2, 2025 Published online: August 24, 2025 Processing time: 102 Days and 1.3 Hours
Abstract
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.
Core Tip: This study demonstrates that combining transarterial chemoembolization (TACE) with programmed cell death (ligand) 1 inhibitors and molecular targeted therapy significantly reduces TACE resistance and improves survival in advanced hepatocellular carcinoma. The combination therapy prolongs progression-free survival and overall survival. Additionally, the study identifies maximum tumor diameter, tumor capsule integrity, and bilobar distribution of tumor as key factors influencing TACE resistance, providing new insights for optimizing treatment strategies.
