TACE-HAIC combined with apatinib and camrelizumab for unresectable hepatocellular carcinoma with portal vein tumor thrombus: a multicenter retrospective study.
Zhang X, Shi S, et al. • Frontiers in immunology • 2026
In patients with unresectable hepatocellular carcinoma accompanied by portal vein tumor thrombus, the THAC regimen (TACE-HAIC combined with apatinib and camrelizumab) was associated with superior survival outcomes compared with the TAC regimen (TACE combined with apatinib and camrelizumab) while maintaining an acceptable safety profile.
Key Findings
Results
The THAC group achieved significantly higher intrahepatic tumor objective response rate and disease control rate compared to the TAC group after propensity score matching.
Intrahepatic tumor ORR: 70.9% (THAC) vs. 47.7% (TAC), P = 0.002
Intrahepatic tumor DCR: 94.2% (THAC) vs. 79.1% (TAC), P = 0.004
After PSM, 86 matched patients were included in each group with well-balanced baseline characteristics
Original cohort included 105 patients in THAC group and 117 in TAC group across five tertiary medical centers in China
Results
The THAC group demonstrated significantly higher portal vein tumor thrombus response rates compared to the TAC group.
PVTT ORR: 61.6% (THAC) vs. 41.9% (TAC), P = 0.009
PVTT DCR: 90.7% (THAC) vs. 74.4% (TAC), P = 0.005
These findings indicate that adding HAIC to the regimen improved tumor thrombus response in addition to intrahepatic tumor control
Results
Median progression-free survival was significantly longer in the THAC group than in the TAC group.
Median PFS: 12 months (THAC) vs. 7 months (TAC)
HR = 0.287; 95% CI: 0.204–0.403; P < 0.001
This represents a 5-month improvement in median PFS for the THAC regimen
Results
Median overall survival was significantly prolonged in the THAC group compared to the TAC group.
Median OS: 24 months (THAC) vs. 16 months (TAC)
HR = 0.198; 95% CI: 0.135–0.291; P < 0.001
This represents an 8-month improvement in median OS for the THAC regimen
OS was a primary endpoint of the study alongside PFS
Results
The incidence of adverse events did not differ significantly between the THAC and TAC groups, and all adverse events were manageable.
Incidence of adverse events did not differ significantly between the two groups (P > 0.05)
No grade 5 adverse events were observed in either group
All adverse events were described as manageable
The safety profile of the THAC regimen was characterized as 'acceptable'
Methods
This multicenter retrospective study used propensity score matching to minimize confounding bias between treatment groups.
Study included patients treated at five tertiary medical centers in China between December 2021 and April 2025
222 total patients met eligibility criteria before PSM (105 THAC, 117 TAC)
PSM resulted in 86 matched patients per group
Primary endpoints were PFS and OS; secondary endpoints included ORR and safety
What This Means
This research examined a combination treatment approach for a particularly difficult-to-treat form of liver cancer. The study focused on patients with unresectable hepatocellular carcinoma (the most common type of liver cancer) that had also spread into a major blood vessel called the portal vein — a condition known as portal vein tumor thrombus, which typically signals a poor outcome. Researchers compared two treatment combinations: one group received TACE (a procedure that delivers chemotherapy directly to liver tumors while blocking their blood supply), HAIC (another method of delivering chemotherapy directly through an artery to the liver), plus two drugs — apatinib (which blocks tumor blood vessel growth) and camrelizumab (an immunotherapy drug). The other group received the same regimen but without HAIC. The study included 222 patients from five hospitals in China, and statistical techniques were used to make the two groups as comparable as possible.
This research suggests that adding HAIC to the treatment combination produced meaningfully better outcomes. Patients who received all four components (TACE, HAIC, apatinib, and camrelizumab) had higher rates of tumor shrinkage — about 71% showed a response in their liver tumors compared to 48% in the group without HAIC. Tumor thrombus in the portal vein also responded better, with about 62% responding versus 42%. Patients in the more intensive combination group lived longer without their disease progressing (median of 12 months vs. 7 months) and had a longer overall survival (median of 24 months vs. 16 months). Importantly, the more intensive regimen did not appear to cause significantly more side effects, and no treatment-related deaths occurred in either group.
These findings matter because portal vein tumor thrombus in liver cancer is associated with very poor prognosis and limited treatment options. This research suggests that combining locoregional liver-directed therapies (TACE and HAIC) with targeted therapy and immunotherapy may offer a more effective approach for these patients than using fewer components. However, because this was a retrospective study (looking back at existing medical records rather than a controlled clinical trial), the findings should be interpreted with caution and would benefit from confirmation in prospective randomized trials.
Zhang X, Shi S, Su Y, Ma Y, Guo Q, Meng X, et al.. (2026). TACE-HAIC combined with apatinib and camrelizumab for unresectable hepatocellular carcinoma with portal vein tumor thrombus: a multicenter retrospective study.. Frontiers in immunology. https://doi.org/10.3389/fimmu.2026.1917667