Background  Immune checkpoint inhibitors have achieved preliminary results in the treatment of a variety of solid tumors, but the efficacy of their combined targeting and local intervention in patients with intermediate and advanced hepatocellular carcinoma needs to be further studied.

  Objective  To investigate the efficacy and safety of trans arterial chemoembolization (TACE) combined with targeted drugs and immune checkpoint inhibitors in patients with intermediate and advanced hepatocellular carcinoma.

  Methods  Clinical data about patients with hepatocellular carcinoma diagnosed pathologically or clinically in the First Medical Center of Chinese PLA General Hospital from January 2016 to January 2021 were retrospectively collected. A total of 150 patients with intermediate and advanced hepatocellular carcinoma were enrolled according to different treatment regimens, 98 patients in the observation group were treated with TACE combined with targeted drugs and immune checkpoint inhibitors, 52 patients in the control group were treated with TACE combined with targeted drugs. The objective response rate (ORR), disease control rate (DCR), overall survival (OS) and adverse reactions of the two groups were analyzed.

  Results   There were 98 cases in the observation group, including 83 males and 15 females, with an average age of 55.5 years. Fifty-two cases were in the control group, including 43 males and 9 females, with an average age of 53.7 years. There was no statistically significant difference in age and gender between the two groups (P＞0.05). The ORR of the observation group and the control group was 56.1% and 38.5%, respectively, and the DCR was 81.6% and 69.2%, respectively. The median overall survival (mOS) was 23.1 months and 16.27 months, respectively (all P＜0.05). The most common adverse events were hypertension (22.4%), diarrhea (21.4%), hand-foot syndrome (20.4%) in the observation group, and hand-foot syndrome(32.7%), diarrhea (19.2%), hypertension (15.4%) in the control group, showing no significant differences between the two groups (P＞0.05).

  Conclusion  TACE combined with targeted drugs and immune checkpoint inhibitors brings hope to prolong the survival time of patients with intermediate and advanced hepatocellular carcinoma, which is expected to promote the new situation of local intervention and drug combination therapy.