TACE-HAIC plus targeted therapy and immune checkpoint inhibitors for unresectable hepatocellular carcinoma: a systematic review and meta-analysis of TACE- and HAIC-based comparisons
- 1Department of Interventional Radiology, The First Affiliated Hospital of Henan University of Science and Technology
Abstract
Background: Against the backdrop of targeted therapy and immune checkpoint inhibitors (ICIs), the additional benefit of combining TACE and HAIC remains uncertain in unresectable hepatocellular carcinoma (uHCC). We separately evaluated TACE-based and HAIC-based comparator strategies.
Methods: CNKI, the Cochrane Library, Embase, PubMed, SinoMed, VIP, Wanfang, and Web of Science were searched from inception to 19 August 2026. Overall survival (OS) was designated as the sole primary efficacy outcome; progression-free survival (PFS), objective response rate (ORR), disease control rate (DCR), and complete response (CR) were secondary efficacy outcomes. Comparator-specific random-effects meta-analyses were performed. Risk of bias for survival outcomes was assessed using ROBINS-I, and certainty of evidence across outcomes was evaluated using GRADE.
Results: In all, 14 retrospective cohort studies were included. The TACE-based and HAIC-based OS analyses included nine and five comparisons involving 1,510 and 572 participants, respectively. Compared with TACE plus targeted therapy and ICIs, TACE-HAIC plus targeted therapy and ICIs was associated with a lower hazard of death (HR = 0.59, 95% CI: 0.47–0.75) and progression or death (HR = 0.65, 95% CI: 0.55–0.78), and with higher ORR (RR = 1.34, 95% CI: 1.19–1.52), DCR (RR = 1.14, 95% CI: 1.07–1.21), and CR (RR = 2.17, 95% CI: 1.46–3.21). Against an HAIC-based comparator, TACE-HAIC was associated with a lower hazard of death (HR = 0.56, 95% CI: 0.43–0.72) and progression or death (HR = 0.64, 95% CI: 0.48–0.86), and with a higher ORR (RR = 1.24, 95% CI: 1.03–1.50), whereas DCR and CR showed no clear between-group differences. Overall grade ≥3 TRAEs were imprecisely estimated in both comparisons (TACE-based: RR = 1.16, 95% CI: 0.81–1.67; HAIC-based: RR = 1.27, 95% CI: 0.92–1.74).
Conclusions: TACE-HAIC plus targeted therapy and ICIs was associated with improved survival and tumor-response outcomes compared with a TACE-based regimen. Against an HAIC-based regimen, associations favored TACE-HAIC for OS, PFS, and ORR in the main analyses, although the PFS and ORR findings were less robust in sensitivity analyses. Available evidence is insufficient to determine whether TACE-HAIC increases the overall risk of grade ≥3 TRAEs. The certainty of evidence was low to very low, and prospective validation is required.
Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261286742 , identifier CRD420261286742.
Related
- Conversion Surgery After HAIC-Based Combination Therapy with Targeted Therapy and Immune Checkpoint Inhibitors for Initially Unresectable Hepatocellular Carcinoma: A Retrospective Cohort Study
- Association between antibiotic exposure and survival outcomes in hepatocellular carcinoma patients treated with immune checkpoint inhibitors: a systematic review and meta-analysis
- Risk Factors for Pneumonitis in Patients with Unresectable Advanced Non-small Cell Lung Cancer Treated with Immune Checkpoint Inhibitors
- Efficacy and safety of hepatic arterial infusion chemotherapy combined with tyrosine kinase inhibitors and PD-1 inhibitors for unresectable hepatocellular carcinoma: a meta-analysis
- Early on-treatment alpha-fetoprotein and des-gamma-carboxy prothrombin responses are associated with outcomes in unresectable hepatocellular carcinoma receiving transarterial chemoembolization, tyrosine kinase inhibitors and programmed cell death protein-1 inhibitors.
BibTeX
@article{li2026tacehaic,
title = {{TACE-HAIC plus targeted therapy and immune checkpoint inhibitors for unresectable hepatocellular carcinoma: a systematic review and meta-analysis of TACE- and HAIC-based comparisons}},
author = {Peizhuo Li and Hao Li and Boyu Mei and Simin Feng and Huanzhang Niu},
journal = {Frontiers in Oncology},
year = {2026},
month = oct,
doi = {10.3389/fonc.2026.1942009},
url = {https://www.frontiersin.org/articles/10.3389/fonc.2026.1942009/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - TACE-HAIC plus targeted therapy and immune checkpoint inhibitors for unresectable hepatocellular carcinoma: a systematic review and meta-analysis of TACE- and HAIC-based comparisons
AU - Peizhuo Li
AU - Hao Li
AU - Boyu Mei
AU - Simin Feng
AU - Huanzhang Niu
PY - 2026
DA - 2026/10/23
JO - Frontiers in Oncology
DO - 10.3389/fonc.2026.1942009
UR - https://www.frontiersin.org/articles/10.3389/fonc.2026.1942009/full
AB - Background: Against the backdrop of targeted therapy and immune checkpoint inhibitors (ICIs), the additional benefit of combining TACE and HAIC remains uncertain in unresectable hepatocellular carcinoma (uHCC). We separately evaluated TACE-based and HAIC-based comparator strategies. Methods: CNKI, the Cochrane Library, Embase, PubMed, SinoMed, VIP, Wanfang, and Web of Science were searched from inception to 19 August 2026. Overall survival (OS) was designated as the sole primary efficacy outcome; progression-free survival (PFS), objective response rate (ORR), disease control rate (DCR), and complete response (CR) were secondary efficacy outcomes. Comparator-specific random-effects meta-analyses were performed. Risk of bias for survival outcomes was assessed using ROBINS-I, and certainty of evidence across outcomes was evaluated using GRADE. Results: In all, 14 retrospective cohort studies were included. The TACE-based and HAIC-based OS analyses included nine and five comparisons involving 1,510 and 572 participants, respectively. Compared with TACE plus targeted therapy and ICIs, TACE-HAIC plus targeted therapy and ICIs was associated with a lower hazard of death (HR = 0.59, 95% CI: 0.47–0.75) and progression or death (HR = 0.65, 95% CI: 0.55–0.78), and with higher ORR (RR = 1.34, 95% CI: 1.19–1.52), DCR (RR = 1.14, 95% CI: 1.07–1.21), and CR (RR = 2.17, 95% CI: 1.46–3.21). Against an HAIC-based comparator, TACE-HAIC was associated with a lower hazard of death (HR = 0.56, 95% CI: 0.43–0.72) and progression or death (HR = 0.64, 95% CI: 0.48–0.86), and with a higher ORR (RR = 1.24, 95% CI: 1.03–1.50), whereas DCR and CR showed no clear between-group differences. Overall grade ≥3 TRAEs were imprecisely estimated in both comparisons (TACE-based: RR = 1.16, 95% CI: 0.81–1.67; HAIC-based: RR = 1.27, 95% CI: 0.92–1.74). Conclusions: TACE-HAIC plus targeted therapy and ICIs was associated with improved survival and tumor-response outcomes compared with a TACE-based regimen. Against an HAIC-based regimen, associations favored TACE-HAIC for OS, PFS, and ORR in the main analyses, although the PFS and ORR findings were less robust in sensitivity analyses. Available evidence is insufficient to determine whether TACE-HAIC increases the overall risk of grade ≥3 TRAEs. The certainty of evidence was low to very low, and prospective validation is required. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261286742 , identifier CRD420261286742.
SN - 2234-943X
ER -