Efficacy Analysis of TACE Combined with Lenvatinib and PD-1 Inhibitors in the Treatment of Hepatitis B Virus-Related Unresectable Hepatocellular Carcinoma.

Background: To explore the impact of hepatitis B virus (HBV) DNA on the efficacy of triple therapy [transarterial chemoembolization (TACE), lenvatinib, and programmed cell death protein-1 (PD-1) inhibitors] in the treatment of HBV-related unresectable hepatocellular carcinoma (u-HCC).

Methods: We retrospectively collected clinical data on triple therapy for HBV-related u-HCC from January 2020 to January 2024 at Xiangyang Central Hospital. Patients with HBV-DNA ≤ 1000 IU/mL were designated the low HBV-DNA level group, and patients with HBV-DNA > 1000 IU/mL were designated the high HBV-DNA level group. The primary endpoint of this study was to compare the progression-free survival (PFS) and overall survival (OS), between the low HBV-DNA level and high HBV-DNA level groups. The secondary endpoint compares the objective response rate (ORR) between the two groups.

Results: Data from 95 patients were obtained, with 41 patients in the low HBV-DNA level group and 54 patients in the high HBV-DNA level group. After treatment, the median PFS and OS was 10.00 months and 25.03 months in the low HBV-DNA level group and 7.23 months and 15.00 months in the high HBV-DNA level group (all P < 0.05). The low HBV-DNA level group had an ORR of 30 patients, and the high HBV-DNA level group had 32 patients (85.37% vs 64.81%, P = 0.024).

Conclusion: HBV-DNA > 1000 IU/mL is associated with poorer prognosis in patients with HBV-related u-HCC treated with triple therapy. In triple therapy for HBV-related u-HCC, HBV-DNA levels above 1000 IU/mL should be actively controlled.