Camrelizumab and Apatinib With or Without Transarterial Chemoembolisation as First-Line Treatment for Advanced Hepatocellular Carcinoma (CHANCE2311)

Background: This real-world study aimed to evaluate and compare the efficacy and safety of two treatment strategies for advanced hepatocellular carcinoma (HCC): transarterial chemoembolisation (TACE) combined with camrelizumab and apatinib versus camrelizumab and apatinib alone. Methods: In this nationwide, multi-centre retrospective cohort study, data were collected on patients with advanced HCC who received either TACE combined with camrelizumab and apatinib (T-C-A) or camrelizumab and apatinib alone (C-A) between January 2018 and December 2022. To reduce potential bias, stabilised inverse probability of treatment weighting (sIPTW) was applied. The primary outcome was overall survival (OS), while secondary outcomes included progression-free survival (PFS), objective response rate (ORR) based on RECIST v1.1 criteria, and safety. Results: A total of 252 HCC patients were included (T-C-A group, n = 183; C-A group, n = 69). Among them, 210 were males and 42 were females, with a median age of 54 years. After sIPTW, the median OS was significantly longer in the T-C-A group compared to the C-A group (24.2 months [95% CI: 21.4–33.4] vs. 15.2 months [95% CI: 9.8–21.0]; p < 0.001). The T-C-A group also demonstrated a significantly improved median PFS of 10.1 months [95% CI: 8.8–12.2], compared to 4.9 months [95% CI: 4.0–12.5] in the C-A group (p < 0.001). Further, the ORR was higher in the T-C-A group. Grade 3/4 adverse events were reported in 12.0% of patients in the T-C-A group and 14.5% in the C-A group. Conclusion: The combination of TACE with camrelizumab and apatinib suggests potential survival advantages for patients with advanced HCC while maintaining an acceptable safety profile.