In a retrospective PSM analysis, TACE combined with donafenib and camrelizumab (triple therapy) was associated with longer median overall survival (15.90 vs 9.10 months) and progression-free survival (11.20 vs 7.10 months) compared to TACE plus donafenib alone in HCC patients with portal vein tumor thrombus.
The TACE+D+C group was associated with significantly longer median overall survival compared to the TACE+D group.
The TACE+D+C group was associated with significantly longer median progression-free survival compared to the TACE+D group.
The TACE+D+C group demonstrated markedly higher objective response rate and disease control rate for intrahepatic lesions.
The TACE+D+C group demonstrated higher tumor response rates in portal vein tumor thrombus compared to the TACE+D group.
The incidence of adverse events after TACE was similar between both groups, with only mild immune-related adverse events unique to the TACE+D+C group.
The study enrolled patients with HCC complicated by PVTT from two medical centers between December 2021 and July 2025, with propensity score matching used to balance baseline confounding factors.
This research suggests that combining transarterial chemoembolization (TACE), a procedure that delivers chemotherapy directly to liver tumors while blocking their blood supply, with two drugs—donafenib (a targeted therapy) and camrelizumab (an immunotherapy)—may offer meaningful benefits for patients with liver cancer (hepatocellular carcinoma) that has spread into the portal vein, a condition called portal vein tumor thrombus (PVTT). Patients who received this triple therapy lived a median of about 15.9 months compared to 9.1 months for those who received TACE plus donafenib alone, and they also went longer before their disease progressed (11.2 versus 7.1 months). Tumor shrinkage rates were also substantially higher with the triple therapy, both for tumors in the liver and for the clots in the portal vein. In terms of safety, the overall rate of side effects from TACE was similar between the two groups. Patients receiving camrelizumab did experience some immune-related side effects unique to that drug, but these were all mild (grade 1-2) and no severe immune-related reactions were observed. This suggests the combination may be reasonably well-tolerated. This research is based on a retrospective analysis—meaning it looked back at existing patient records rather than conducting a controlled experiment—and propensity score matching was used to try to make the two groups of patients comparable. The authors themselves caution that these results cannot establish that triple therapy is definitively superior and that prospective randomized controlled trials are needed to confirm these findings. Nevertheless, the results suggest this triple-combination approach may be a promising treatment strategy for a particularly difficult-to-treat form of liver cancer.
Zhang Q, Qing H, Lei Z, Xie X. (2026). Efficacy and safety of transarterial chemoembolization combined with donafenib and camrelizumab for hepatocellular carcinoma with portal vein tumor thrombus: a dual-center, retrospective propensity score-matched analysis.. Frontiers in immunology. https://doi.org/10.3389/fimmu.2026.1882605