Real-world efficacy and safety of TACE-HAIC combined with TKIs and PD-1 inhibitors in initially unresectable hepatocellular carcinoma

•Efficacy and safety of TACE and HAIC combined with TKIs and PD-1 inhibitors in unresectable hepatocellular carcinoma (uHCC) were evaluated.•Key findings: median overall survival (OS) 18.2 months, progression-free survival (PFS) 9.2 months, objective response rate (ORR) 67.7 %, disease control rate (DCR) 90.3 %, and conversion surgery rate (CSR) 27.4 %.•Converted patients is superior to that of other enrolled patients on OS and PFS.•Main adverse events included transaminitis, nausea, and fever.•This combination therapy demonstrates effectiveness, particularly in enhancing survival post-surgery in uHCC patients. Local treatment may function synergistically with immunotherapy and targeted agents. This study aimed to assess the effectiveness and safety of transcatheter arterial chemoembolization (TACE) and hepatic artery infusion chemotherapy (HAIC) combined with tyrosine kinase inhibitors (TKIs) and programmed death-1 (PD-1) inhibitors in patients with initially unresectable hepatocellular carcinoma (uHCC). A retrospective study was conducted on patients diagnosed with initially uHCC who received combined treatment of TACE-HAIC combined with TKIs and PD-1 inhibitors from July 2020 to February 2023. The primary endpoints were overall survival (OS) and progression free survival (PFS) and adverse events (AEs). Objective response rate (ORR), disease control rate (DCR) and conversion surgery rate (CSR), whereas the secondary endpoints. After screening, a total of 62 patients were selected for this study. The overall median OS was 18.2 (95% CI 16.24–20.16) months and median PFS was 9.2 (95% CI 7.24–11.16) months. Based on the modified Response Evaluation Criteria in Solid Tumors (mRECIST) criteria and RECIST v1.1 criteria, ORR was 67.7% (42/62), and the DCR was 90.3% (56/62), the CSR was 27.4% (17/62). The most common treatment-emergent adverse events (TEAEs) were transaminitis (56.4%, 35/62), nausea and vomiting (43.5%, 27/62), thrombocytopenia (37.1%, 23/62), abdominal pain (33.9%, 21/62), and fever (33.9%, 21/62). TKIs combined with PD-1 inhibitors plus TACE-HAIC therapy represents an effective and tolerable treatment option in patients with uHCC. Patients undergoing surgery after combination therapy may have survival benefits.