Transarterial Chemoembolization, Immunotherapy and Lenvatinib for Intrahepatic Cholangiocarcinoma: A Real-World Study

Introduction : Intrahepatic cholangiocarcinoma (ICC) carries a rising mortality rate and poor prognosis, with current chemotherapy-based first-line standards offering limited survival benefits and high toxicity. Integrating transarterial chemoembolization (TACE) with immune checkpoint inhibitors (ICIs) and lenvatinib may enhance antitumor immunity. This multicenter study evaluated the efficacy and safety of this triple therapy (TACE-ICIs-Len) compared to standard first-line regimens. Methods : A total of 216 patients with advanced ICC were retrospectively analyzed and categorized into three groups: chemotherapy alone (Chemo, n = 74), ICIs plus chemotherapy (ICIs-Chemo, n = 82), and TACE-ICIs-Len (n = 60). Outcomes included overall survival (OS), progression-free survival (PFS), objective response rate (ORR), disease control rate, and safety. Results : The TACE-ICIs-Len group demonstrated a significant survival advantage, achieving a median OS of 20.6 months compared to 14.7 months for ICIs-Chemo and 14.0 months for Chemo (P = 0.036). Median PFS was also superior in the TACE-ICIs-Len group (11.3 vs. 6.5 vs. 5.6 months; P = 0.003). Furthermore, the triple-combination yielded a significantly higher ORR (51.7%) and a 10% conversion surgery rate. Multivariate analysis identified the TACE-ICIs-Len regimen and CEA levels as independent prognostic factors for both PFS and OS. Safety profiles were manageable across all groups. Conclusion : TACE combined with ICIs and lenvatinib is a potent and well-tolerated first-line strategy that significantly improves survival and tumor response in patients with advanced ICC.