To evaluate the efficacy and safety of targeted therapy plus immunotherapy ± transcatheter arterial chemoembolization (TACE)/radiotherapy for conversion therapy in initially unresectable intermediate-to-advanced hepatocellular carcinoma (HCC).

We retrospectively analyzed 20 patients with Barcelona clinic liver cancer (BCLC) stage B/C HCC treated with targeted therapy and immunotherapy; 19 received concurrent TACE, and 4 received radiotherapy among them. The evaluation indicators include objective response rate (ORR), microscopic margin-negative (R0) resection rate and safety.

The overall ORR and the disease control rate were 55% and 85%, respectively. Four patients (20%) successfully underwent R0 resection, with 2 achieving major pathological response. The incidence of grade ≥3 adverse events was 20%, primarily immune-related liver injury. At a median follow-up of 18.3 months, 3 of the 4 resected patients remained recurrence-free 12 months post-surgery.

The multimodal approach centered on targeted combined immunotherapy has a significant ability to downstage advanced HCC. The R0 resection rate is 20%, and the pathological remission is remarkable with controllable safety.