Efficacy and Safety of Transarterial Chemoembolization Combined with PD-1 Inhibitors plus Molecular Targeted Therapies for Unresectable Hepatocellular Carcinoma with Child‒Pugh B

Background and Objectives To assess the efficacy and safety of transarterial chemoembolization (TACE) combined with programmed cell death-1 (PD-1) inhibitors plus molecular targeted therapies (MTT) for unresectable hepatocellular carcinoma (HCC) with Child-Pugh (CP)-B (score of 7-8). Methods This multicenter retrospective study enrolled patients with unresectable HCC receivingTACE combined with PD-1 inhibitors plus MTT between January 2019 and December 2022. Propensity score matching (PSM) was performed to reduce bias between the CP-A and CP-B (score of 7-8) groups. The primary outcome was overall survival (OS)and the secondary outcomes included progression-free survival (PFS), objective response rate (ORR), disease control rate (DCR), and adverse events (AEs). Results A total of 416 patients were ultimately included in the study. The median OS was 26.4 months (95% CI, 22.7-30.0) for the overall population during a median follow-up period of 32.5 months. The median OS was greater in patients with CP-A liver function than in patients with CP-B (score of 7-8), but the difference was not statistically significant. After PSM, the OS, PFS, ORR, and DCR of CP-A patients were comparable to those of CP-B (score of 7-8) patients. No significant difference was observed in the incidence of grade 3/4 AEs between the two groups. Conclusions Unresectable HCC patients with CP-B (score of 7-8) undergoing TACE combined with PD-1 inhibitors plus MTT showed similar clinical activity and safety profiles compared to CP-A patients.