Lenvatinib plus transarterial chemoembolization (TACE)have become the first choice for patients with hepatocellular carcinoma (HCC) that are unsuitable for TACE. Sorafenib plus TACE therapy for patients with portal vein tumor thrombus (PVTT) achieved positive results. However, Lenvatinib plus TACE appeared to achieve a more advantageous result for these patients based on the phase 3 REFLECT trial. Both TACE and lenvatinib therapy have immune-stimulating effects, so would lenvatinib plus TACE and immune checkpoint inhibitors be an advantageous therapy for unresectable HCC (uHCC)? Thirteen articles from PubMed were explored to determine the efficacy and safety of lenvatinib plus TACE with or without PD-1 inhibitors therapy. Most of the adverse events (AEs) were manageable. Lenvatinib plus TACE therapy was superior to lenvatinib monotherapy with intermediate stage HCC especially beyond up-to-seven criterion and was superior to TACE monotherapy in patients with uHCC or sorafenib plus TACE therapy in patients with PVTT. Objective response rates (ORRs) of 53.1%–75%, median progression free survival (PFS) of 6.15–11.6 months, and median overall survival (OS) of 14.5–18.97 months were achieved in the lenvatinib plus TACE group. Levatinib plus TACE and PD-1 inhibitors achieved ORRs of 46.7% –80.6%, median PFS of 7.3–13.3 months, and median OS of 16.9–24 months. Control studies also confirmed the triple therapy was superior to lenvatinib plus TACE in patients with uHCC. Overall, the triple therapy is a promising treatment for patients with uHCC, including main PVTT and extrahepatic metastasis. Lenvatinib plus TACE therapy was also preferable for intermediate stage HCC beyond up-to-seven criterion and for patients with PVTT.

乐伐替尼联合经动脉化疗栓塞（TACE）已成为不适合TACE的肝细胞癌（HCC）患者的首选。索拉非尼联合 TACE 治疗门静脉癌栓 (PVTT) 患者取得积极成果。然而，基于 3 期 REFLECT 试验，Lenvatinib 加 TACE 似乎对这些患者取得了更有利的结果。TACE 和乐伐替尼治疗都具有免疫刺激作用，那么乐伐替尼加 TACE 和免疫检查点抑制剂是否会成为不可切除 HCC (uHCC) 的有利疗法？探索了 PubMed 的 13 篇文章，以确定乐伐替尼加 TACE 联合或不联合 PD-1 抑制剂治疗的疗效和安全性。大多数不良事件 (AE) 是可控的。乐伐替尼联合 TACE 治疗优于乐伐替尼单药治疗，尤其是超过 7 项标准，在 uHCC 患者中优于 TACE 单药治疗，在 PVTT 患者中优于索拉非尼联合 TACE 治疗。乐伐替尼联合 TACE 组的客观缓解率 (ORR) 为 53.1%–75%，中位无进展生存期 (PFS) 为 6.15–11.6 个月，中位总生存期 (OS) 为 14.5–18.97 个月。Levatinib 加 TACE 和 PD-1 抑制剂的 ORR 为 46.7% –80.6%，中位 PFS 为 7.3–13.3 个月，中位 OS 为 16.9–24 个月。对照研究还证实，三联疗法在 uHCC 患者中优于乐伐替尼加 TACE。总体而言，包括主要 PVTT 和肝外转移在内的三联疗法对于 uHCC 患者来说是一种很有前景的治疗方法。