Outcomes of RALOX-HAIC-based Combination Therapy for Unresectable Hepatocellular Carcinoma with Radiomics-Powered Prediction.

[RATIONALE AND OBJECTIVES] Unresectable hepatocellular carcinoma (uHCC) remains a formidable clinical challenge owing to the scarcity of effective treatment options and unsatisfactory therapeutic responses. The current study explored a combined regimen of RALOX-HAIC, lenvatinib, and camrelizumab in patients with uHCC. In addition, a radiomics-based nomogram was created to predict treatment outcomes and support individualized decision-making.

[METHODS] A total of 98 patients with uHCC received RALOX-HAIC, along with lenvatinib and camrelizumab. Before initiating therapy, radiomics features were derived from pretreatment computed tomography (CT) images and subsequently integrated with clinical variables, such as HBV status and Child-Pugh score. A radiomics nomogram was generated and assessed based on the area under the receiver operating characteristic curve (AUC), calibration analysis, and decision curve analysis (DCA).

[RESULTS] Triple therapy yielded an objective response rate (ORR) of 52.0%, disease control rate (DCR) of 90.8%, and median progression-free survival (PFS) of 10.7 months (95% CI: 7.3-20.5). The radiomics-guided nomogram showed high accuracy in the training (AUC: 0.986) and validation (AUC: 0.873) sets. The calibration curves showed close agreement between the projected and observed outcomes, and DCA confirmed the notable clinical merit. The main grade ≥3 toxicities included neutropenia and thrombocytopenia (68.4%), consistent with the profiles observed in comparable therapies.

[CONCLUSION] The integrated approach exhibited promising antitumor activity and an acceptable safety profile. Moreover, the radiomics nomogram is a valuable tool for refining patient selection and advancing personalized treatment strategies for individuals with uHCC.