TACE Combined with Hepatic Arterial Infusion of Nivolumab for Inhibiting Tumor Angiogenesis in Hepatocellular Carcinoma

Objective: This study aims to explore the clinical efficacy of transarterial chemoembolization (TACE) combined with the immune checkpoint inhibitor nivolumab administered via hepatic arterial infusion (HAI) in inhibiting tumor angiogenesis in hepatocellular carcinoma (HCC). Methods: A total of 140 patients diagnosed with HCC at our hospital from October 2021 to October 2022 were analyzed. They were randomly divided into a study group (n=70), receiving TACE combined with HAI of nivolumab, and a control group (n=70), receiving TACE alone. The efficacy and adverse reactions of both groups were compared. Levels of angiogenesis factors (VEGF, VEGFR-2, Ang-2) and tumor markers (CEA, AFP, CA19-9) were measured one day before and one month after treatment, followed by patient follow-up. Results: The objective response rate (ORR) and disease control rate (DCR) in the study group were significantly higher than those in the control group (64.3% vs. 42.9%, P=0.006 and 91.4% vs. 70.0%, P=0.001, respectively). One day before treatment, there was no significant difference in the levels of VEGF, VEGFR-2, and Ang-2 between the two groups (P > 0.05). One month after treatment, the study group showed significantly lower levels of VEGF, VEGFR-2, and Ang-2 compared to the control group (all P < 0.001). Similarly, there was no significant difference in CEA, AFP, and CA19-9 levels before treatment (P > 0.05), but one month after treatment, the study group had significantly lower levels of these markers (P < 0.001). The incidence of adverse reactions between the two groups showed no significant difference (P > 0.05). All 140 patients were followed up for a median of 13.87 months. The median overall survival was 15.4 months in the study group versus 13.4 months in the control group (P < 0.05), and median progression-free survival was 9.5 months versus 9.0 months, respectively (P < 0.05). Conclusion: TACE combined with hepatic arterial infusion of nivolumab can effectively inhibit tumor angiogenesis in HCC, improve clinical outcomes, and maintain a high safety profile, representing a promising therapeutic strategy for patients with unresectable HCC.