Efficacy and safety of bronchial arterial infusion chemotherapy combined with transarterial chemoembolization and systemic therapy in hepatocellular carcinoma patients with lung metastases

This study evaluated the efficacy and safety of bronchial arterial infusion (BAI) chemotherapy combined with transarterial chemoembolization (TACE) plus systemic therapy in hepatocellular carcinoma (HCC) patients with lung metastases. This study retrospectively analyzed 54 HCC patients with lung metastases who underwent TACE combined with systemic therapy and/or BAI chemotherapy, at initial diagnosis from January 2018 to June 2023. Systemic therapy included targeted agents (apatinib, lenvatinib, and regorafenib, or bevacizumab) and programmed cell death protein 1 (PD-1) inhibitors (sintilimab, camrelizumab, and tislelizumab). During follow-up, treatment-related adverse events were recorded. Progression-free survival (PFS) was assessed separately for lung metastases and intrahepatic lesions, along with overall survival (OS). Fifty-four eligible patients with HCC were enrolled, including 32 in the BAI plus TACE and systemic therapy group (BTS group) and 22 in the TACE plus systemic therapy group (TS group). At 3 months post-treatment, the BTS group showed significantly higher objective response rate of lung metastatic lesions (50.0% vs. 22.7%, p = .043) and disease control rate (DCR) (93.7% vs. 68.2%, p = .013) than the TS group. By study end, DCR remained higher in the BTS group (84.4% vs. 54.5%, p = .016). Median PFS of lung metastatic lesions was 7.1 versus 3.3 months (p = .004), and median OS was 13.9 versus 7.6 months (p = .009), both favoring the BTS group. The combination of BAI, TACE, and systemic therapy achieved favorable therapeutic outcomes and acceptable safety in patients with HCC with lung metastases.