Complete Remission in BCLC Stage C Hepatocellular Carcinoma Treated with HAIC Combined with PD-1 Inhibitors and Anti-angiogenic Therapy

Hepatocellular carcinoma (HCC) at Barcelona-Clinic Liver Cancer (BCLC) stage C poses substantial therapeutic challenges and is typically associated with a poor survival prognosis. Triple therapy regimen comprising hepatic artery infusion chemotherapy (HAIC), programmed death receptor-1 (PD-1) inhibitors, and anti-angiogenic therapy is currently under investigation for this stage of HCC. In this study, nine advanced cases are reported that achieved complete response (CR) following this triple combination therapy. CR was defined by the complete disappearance of all lesions or the absence of arterial-phase enhancement on CT or MRI, no evidence of new lesions, and normalisation of alpha-fetoprotein (AFP) levels. Time to CR, changes in AFP levels during follow-up, and recurrence rates were analysed. Among 214 patients with HCC treated with this triple therapy at the centre from January 2021 to December 2023, 9 (4.2%) patients achieved CR. The time to CR ranged from 2 to 10 months, with a mean duration of 5.3 months. The duration for AFP levels to normalise varied from 79 to 259 days, with a median duration of 118 days. These findings indicate that the triple combination therapy of HAIC, PD-1 inhibitors, and anti-angiogenic agents has a modest probability of inducing CR in advanced HCC, with relatively rapid onset in responders. Key Words: Hepatocellular carcinoma, Hepatic arterial infusion chemotherapy, Programmed death receptor-1 inhibitors, Anti-angiogenic therapy, Complete remission.