Clinical Efficacy Exploration of Temperature-Sensitive Embolic Agent TACE Combined with HAIC and Targeted/Immunotherapy for Unresectable Primary Liver Cancer

Xingyu Chen,* Heng Xiao,* Xiang Lan, Chengyou Du Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China*These authors contributed equally to this workCorrespondence: Xiang Lan, Department of Hepatobiliary Surgery, The First Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuanjiagang, Yuzhong District, Chongqing, 400016, People’s Republic of China, Tel +86-023-89011191, Email lanxiang_tmmu@163.com Chengyou Du, Department of Hepatobiliary Surgery, The First Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuanjiagang, Yuzhong District, Chongqing, 400016, People’s Republic of China, +86-023-89011192, Email duchengyou@126.comObjective: To evaluate the efficacy and safety of TEM-TACE combined with HAIC and targeted/immunotherapy for the treatment of unresectable primary liver cancer, and to clarify the clinical application potential of this multimodal therapeutic regimen.Methods: This study was a small-sample retrospective case series. The clinical data of 4 patients with unresectable primary liver cancer who underwent TEM-TACE combined with HAIC and targeted/immunotherapy in our hospital from April 2025 to July 2025 were retrospectively analyzed. Tumor response was evaluated according to the mRECIST criteria, and the occurrence of adverse reactions was assessed on the basis of the Clavien–Dindo classification system. All patients included in this study provided written informed consent for the publication of their clinical details.Results: Among the 4 patients, 2 were diagnosed with HCC, and the other 2 were diagnosed with ICC. All 4 patients achieved a PR after treatment with TEM-TACE combined with HAIC and targeted/immunotherapy, with a mean tumor reduction of 42.3%. The ORR and DCR both reached 100%. Among these patients, 2 successfully achieved treatment conversion and underwent radical surgical resection, while the remaining 2 refused surgery for personal reasons. During the perioperative period, only Clavien–Dindo grade I–II complications (mainly abdominal pain and nausea) occurred in the 4 patients, which improved after symptomatic treatment, and no severe adverse reactions were observed.Conclusion: The multimodal therapeutic regimen of TEM-TACE combined with HAIC and targeted/immunotherapy is safe and effective for unresectable primary liver cancer. In particular, compared with conventional embolic agents, temperature-sensitive embolic agents enable precise peripheral embolization and sustained drug release, thereby significantly reducing tumor volume and improving the rate of conversion to surgical resection. Moreover, this regimen provides a novel approach for the conversion therapy of unresectable ICC. It is suitable for patients with primary liver cancer who have a tumor diameter > 10 cm, liver function of Child-Pugh class A/B, and no severe comorbidities. However, further studies with larger sample sizes are still required to verify its long-term efficacy.Keywords: unresectable primary liver cancer, temperature-sensitive embolic agent, transarterial chemoembolization, hepatic artery infusion chemotherapy, combined therapy