Hepatocellular carcinoma (HCC) is a commonly diagnosed malignancy, with the treatment for transplant-ineligible localized disease traditionally relying on locoregional therapies, such as surgical resection, transarterial chemoembolization (TACE), and transarterial radioembolization (TARE). Systemic therapy has historically been reserved for advanced, unresectable HCC. However, lenvatinib, an oral multikinase inhibitor, has recently gained traction as part of a multimodal approach for localized HCC in combination with locoregional treatments. An upfront TACE or TARE can induce tumor hypoxia, leading to the upregulation of hypoxia-inducible factor-1 alpha (HIF-1α) and vascular endothelial growth factor (VEGF), which promotes tumor angiogenesis and progression. The rationale for combining lenvatinib with a locoregional therapy is to enhance tumor shrinkage while preserving liver function before a definitive intervention. Clinical trials, such as TACTICS and LAUNCH, have demonstrated improved outcomes with this approach. Additionally, retrospective studies, including those incorporating immune checkpoint inhibitors, have reported further benefits. This review explores the combination of lenvatinib with various locoregional modalities, including TARE, microwave ablation (MWA), and radiofrequency ablation (RFA), highlighting their indications and clinical outcomes. Furthermore, we discuss the ongoing and upcoming clinical trials investigating the integration of systemic agents with locoregional therapies for intermediate-stage HCC, including EMERALD-1, EMERALD-3, LEAP-012, and CheckMate 74W.
肝细胞癌（HCC）是一种常见的恶性肿瘤，对于不适合肝移植的局限性病灶，传统治疗主要依赖局部区域疗法，如手术切除、经动脉化疗栓塞（TACE）和经动脉放射栓塞（TARE）。系统性治疗历来仅用于晚期不可切除的HCC。然而，口服多激酶抑制剂乐伐替尼近期作为多模式治疗的一部分，与局部区域疗法联合应用于局限性HCC，已获得广泛关注。前期TACE或TARE可诱发肿瘤缺氧，导致缺氧诱导因子-1α（HIF-1α）和血管内皮生长因子（VEGF）上调，从而促进肿瘤血管生成和进展。乐伐替尼与局部区域疗法联合的理论基础在于，在确定性干预前增强肿瘤缩小效果，同时保留肝功能。TACTICS和LAUNCH等临床试验已证实该策略可改善患者预后。此外，包含免疫检查点抑制剂在内的回顾性研究也报告了进一步的获益。本综述探讨乐伐替尼与多种局部区域治疗模式（包括TARE、微波消融和射频消融）的联合应用，重点阐述其适应症和临床结局。同时，我们讨论了当前及即将开展的针对中期HCC系统性药物与局部区域疗法联合的临床试验，包括EMERALD-1、EMERALD-3、LEAP-012和CheckMate 74W研究。
肿瘤(癌症)患者之家