Abstract: Objective To investigate the effect of transcatheter arterial chemoembolization (TACE) combined with tyrosine kinase inhibitors (TKI) and programmed death-1 (PD-1) inhibitors in the conversion therapy for patients with unresectable hepatocellular carcinoma. Methods Clinical data of 22 patients  with unresectable hepatocellular carcinoma receiving TACE combined with TKI and PD-1 inhibitors were collected and analyzed in the hepatocellular carcinoma ward of Guangxi Medical University Cancer Hospital from November 2019 to December 2020. The primary research endpoint was surgical conversion rate, and the secondary research endpoints were tumor response, objective response rate, disease control rate, progression-free survival, overall survival and poor response. Results Among 22 patients, the surgical conversion rate was 45.5% (10/22), the objective remission rate was 81.8% (18/22), and the disease control rate was 90.9% (20/22). The median progression-free survival and the median overall survival did not reach the observation endpoint. The incidence of treatment-related adverse reactions (TRAE) was 100% (22/22), and the incidence of ≥3 grade TRAE was 59% (13/22). Among the 10 patients with successful conversion therapy, the median time from treatment to surgery was 4.7 months (IQR: 3.4-8.4 months), the median operation time was 271 min (IQR: 210-313 min), the median blood loss was 225 mL (IQR: 100-425 mL), the postoperative median drainage tube extubation time was 6.0 d (IQR: 4.8-8.5 d), and the median postoperative hospital stay was 10.0 d( IQR: 8.5-12.3 d); 3 cases had complete remission; the median follow-up time after operation was 3.5 months, and no tumor recurrence or death was found. Conclusions TACE combined with TKI and PD-1 inhibitors may be an effective and safe conversion therapy strategy for unresectable hepatocellular carcinoma.

Key words: Hepatocellular carcinoma, Unresectable, TACE, TKI, PD-1, Conversion therapy