The CHANCE2202 study evaluated whether combining TACE with immune checkpoint inhibitors (ICIs) plus VEGF inhibitors or TKIs improves outcomes compared to TACE alone in intermediate-stage hepatocellular carcinoma (HCC). Using a rigorous target trial emulation framework, this nationwide Chinese multicenter cohort (n=941) attempted to replicate the design principles of a randomised controlled trial while minimising immortal-time and selection bias.
The CHANCE2202 study evaluated whether combining TACE with immune checkpoint inhibitors (ICIs) plus VEGF inhibitors or TKIs improves outcomes compared to TACE alone in intermediate-stage hepatocellular carcinoma (HCC). Using a rigorous target trial emulation framework, this nationwide Chinese multicenter cohort (n=941) attempted to replicate the design principles of a randomised controlled trial while minimising immortal-time and selection bias.
Among 941 patients, 308 received combination therapy, and 633 received TACE monotherapy. Median overall survival (OS) was significantly longer with combination therapy (32.9 vs 23.0 months), with a restricted mean survival time (RMST) gain of 9.2 months and HR 0.57. Median progression-free survival (PFS) was also superior (18.0 vs 12.9 months; RMST difference 6.7 months; HR 0.70). Objective response rate (mRECIST) was higher in the combination group (60.5% vs 44.3%).
Grade ≥3 adverse events were more frequent in the combination arm (20.8% vs 6.8%) but were considered manageable.
Key Takeaways
Real-world evidence suggests meaningful OS and PFS improvement with TACE + ICI + VEGF/TKI.
Benefit was consistent across clinically relevant subgroups.
The safety profile was acceptable, though higher toxicity requires monitoring.
Phase III trials show PFS benefit, but OS data remain immature.
Current evidence is promising but insufficient to change standard BCLC practice pending prospective confirmation.
This study strengthens the biological rationale for integrating locoregional and systemic therapy in intermediate-stage HCC but highlights the need for definitive randomized survival data.
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