Hepatic arterial infusion chemotherapy-based triplet conversion therapy for hepatocellular carcinoma with portal vein tumor thrombus: Evidence, patient selection, and surgical endpoints.

Authors

Chaosheng Xia, Yutao He, Rongfu Hong, Wenda Wang, Hangyu Li, Lin Wang, Zhitian Shi

Published in

Bioscience trends. Aug 28, 2026. Epub Aug 28, 2026.

Abstract

Portal vein tumor thrombus (PVTT) is a biologically aggressive and clinically heterogeneous form of hepatocellular carcinoma (HCC). Global guidelines generally classify macrovascular invasion as advanced disease and prioritize systemic therapy, whereas selected East Asian practice pathways incorporate hepatic arterial infusion chemotherapy (HAIC), radiotherapy, or resection. This review critically evaluates HAIC combined with an antiangiogenic agent and immune checkpoint inhibitor as a conversion strategy for HCC with PVTT. Randomized trials substantiate the efficacy of HAIC-based treatment in contrast to controls from the days of sorafenib but do not establish the incremental benefit of the contemporary triplet. Across prospective single-arm studies, RECIST 1.1 objective response rates ranged from approximately 36 to 77%, with higher estimates in some studies using mRECIST. Retrospective PVTT-focused comparisons also suggest longer progression-free and overall survival than with dual systemic therapy or HAIC alone, but these figures remain vulnerable to confounding by indication, heterogeneous regimens, inconsistent response criteria, and immortal-time bias related to surgery. Conversion should be defined as a prospectively documented transition from unresectable disease to an R0-resectable state with adequate liver reserve, not as radiological response alone. We propose an explicitly unvalidated multidisciplinary framework for candidate selection, reassessment, and perioperative management. Current evidence supports protocol-based use in clinical trials or experienced centers rather than routine global adoption. Randomized PVTT-stratified trials comparing the triplet to contemporary immunotherapy, with intention-to-treat reporting of resection and pathological response, are required.

PMID:
42669488
Bibliographic data and abstract were imported from PubMed on 31 Aug 2026.

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