ORIGINAL RESEARCH article
Front. Immunol.
Sec. Cancer Immunity and Immunotherapy
Volume 16 - 2025 | doi: 10.3389/fimmu.2025.1643290
Triple Therapy Revolutionizes Treatment Paradigms for Previously Untreatable HCC Complicated by High-Flow Hepatic Arteriovenous Fistulas
Provisionally accepted
- 1Department of Interventional Therapy I, Shandong Cancer Hospital and Institute, Jinan, China
- 2Shandong First Medical University, Jinan, China
- 3Laizhou Hospital of Traditional Chinese Medicine, yantai, China
- 4Department of Hepatobiliary Surgery, Shandong Cancer Hospital and Institute, Jinan, China
- 5Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
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Purpose: To evaluate the short-term efficacy and safety of hepatic arterial infusion chemotherapy (HAIC) combined with immune checkpoint inhibitors (ICIs) and tyrosine kinase inhibitors (TKIs) in patients with hepatocellular carcinoma (HCC) complicated by high-flow hepatic arteriovenous fistula (HAVF).We retrospectively analyzed clinical data from 40 patients with unresectable HCC complicated by high-flow HAVF who received FOLFOX regimen HAIC plus ICIs and TKIs between January 2021 and June 2023. The efficacy evaluation included HAVF effective rate, tumor response, progression-free survival (PFS), overall survival (OS) per RECIST 1.1 and mRECIST. Adverse events (AEs) were recorded for safety evaluation.The median follow-up time was 10.5 months (range: 3.5-16.4 months). A total of 150 HAIC cycles were administered, with a median frequency of 3.8 cycles per patient. The objective response rate (ORR) and the disease control rate (DCR) was 42.5% and 92.5% according to the RECIST 1.1, and 75.0% and 92.5% according to mRECIST criteria, respectively. The median PFS and the median OS were 5.5 months (95% CI: 3.9-6.9) and 10.4 months (95% CI: 7.4-13.4), respectively. In univariate analysis, HAVF grade, extrahepatic spread, HAVF disappearance were potential prognostic factors for OS, while HAVF grade and extrahepatic spread being independently associated with PFS. Hypertension (12.5%), Thrombocytopenia (12.5%) and Albumin decreased (7.5%) were the most frequently observed grade 3-4 TRAEs.No treatment-related mortality occurred during the study period.HAIC combined with ICIs and TKIs demonstrates promising short-term efficacy and acceptable safety in patients with unresectable HCC complicated by high-flow HAVF. This combination therapy effectively controls tumor growth while simultaneously managing the arteriovenous shunt, providing a valuable treatment option for this challenging patient population.
Keywords: Hepatocellular Carcinoma, High-flow hepatic arteriovenous fistula, Hepatic arterial infusion chemotherapy, immune checkpoint inhibitors, Tyrosine Kinase Inhibitors HAVF,Hepatic Arteriovenous Fistula, PVTT, Portal vein tumor thrombosis, APS, Arterioportal shunt, TAE, Transcatheter arterial embolization
Received: 08 Jun 2025; Accepted: 21 Jul 2025.
Copyright: © 2025 Li, Li, Zhong, Du, Chen, Shi, Zhao and Song. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Jinpeng Li, Department of Interventional Therapy I, Shandong Cancer Hospital and Institute, Jinan, China
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