Background Recent advances in systemic therapeutic options have significantly improved survival outcomes in patients with advanced hepatocellular carcinoma (HCC). However, optimizing treatment strategies across different disease stages remains a challenge. Combining loco-regional treatments with systemic therapies has gained interest as a potential approach to enhance patient outcomes. In this study, we investigated the efficacy and safety of combining locoregional therapy (transarterial chemoembolization [TACE] or radioembolization [TARE]) with sorafenib in a cohort of Saudi Arabian patients.

Methods We conducted a retrospective analysis of data from 60 HCC patients treated at a tertiary hospital, King Abdullah Medical City, Makkah. Among them, 43 patients received locoregional therapy (LRT) alone (TACE or TARE), while 17 patients were treated with a combination of locoregional therapy and sorafenib (LRTS). Demographic characteristics, BCLC (Barcelona Clinic Liver Cancer) class distribution, treatment response rates, HCC progression, and adverse events were compared between the two groups.

Results The LRT group had a slightly higher mean age (72 years) compared to the LRTS group (68 years), with more pronounced male predominance (88% vs. 81%, respectively). BCLC Stage A and B patients were more prevalent in the LRTS group than in the LRT group (59% vs 42% and 30% and 18%, respectively). The rates of complete response, partial response, and stable disease between LRT and LRTS were 30% vs. 18% (p = 0.32), 30% vs. 42% (p = 0.61) and 19% vs. 12% (p = 0.79). The HCC progression rate was 21% for LRT and 29% for LRTS (p = 0.72). The two-year survival rate was 9% for LRT and 6% for LRTS (p = 0.93). Adverse events were similar between techniques and included liver decompensation, a rise in transaminase, and abdominal pain.

Conclusions Combining loco-regional therapy with sorafenib appears to be a promising approach in the management of HCC. Further prospective studies are warranted to validate these findings and refine treatment algorithms for this challenging malignancy.