AK104 plus TACE with surgery for resectable high‑risk liver cancer (real‑world cohort)

The Real-World Study of Neoadjuvant Immune-Checkpoint Blockade Therapy Combining With TACE For Resectable Hepatocellular Carcinoma With High Recurrence Risk

This project follows people with resectable, high‑risk hepatocellular carcinoma who have surgery without neoadjuvant AK104 plus TACE to compare their outcomes with patients who received the neoadjuvant approach.

Quick facts

• Study type: Observational
• Enrollment: 100 (estimated)
• Ages: 18 Years to 75 Years
• Sex: All
• Sponsor: Sun Yat-sen University (other)
• Drugs / interventions: prednisone
• Locations: 1 site (Guangzhou, Guangdong)
• Trial ID: NCT07064681 on ClinicalTrials.gov

What this trial studies

This observational cohort enrolls patients who met inclusion criteria for a prior Phase 2 neoadjuvant trial but either refused neoadjuvant AK104 plus TACE or are enrolled prospectively under the same criteria. Enrolled participants undergo surgery without neoadjuvant therapy and are monitored regularly, with at least one year of scheduled follow‑up and longer‑term survival tracking. The cohort includes both retrospective and prospective enrollment at The First Affiliated Hospital of Sun Yat‑sen University and uses the same surgical and imaging assessments as the neoadjuvant trial to enable comparison. Data will serve as a real‑world comparator group to the neoadjuvant cohort.

Who should consider this trial

Good fit: Ideal candidates are adults 18–75 years with treatment‑naïve, resectable BCLC A/B hepatocellular carcinoma at high risk for recurrence, ECOG 0–1, Child‑Pugh A, and meeting the study's laboratory and imaging eligibility criteria.

Not a fit: Patients who have already received neoadjuvant therapy, have unresectable disease, poor liver function (Child‑Pugh B/C), ECOG >1, or significant comorbidities are unlikely to benefit from participation.

Why it matters

Potential benefit: If successful, this will provide real‑world evidence about outcomes after surgery alone versus neoadjuvant AK104 plus TACE, helping clinicians decide whether the neoadjuvant approach adds benefit for high‑risk resectable HCC.

How similar studies have performed: Early‑phase studies of neoadjuvant immunotherapy combined with locoregional treatments like TACE have shown promising signals, but direct real‑world comparative cohorts are still limited.

Eligibility criteria

Inclusion Criteria:

1. Age ≥18 years but ≤75 years
2. Resectable HCC staged BCLC A/B
3. Treatment naïve for HCC
4. High risk for recurrence, meeting at least one of the following criteria:

   1. Multiple tumor lesions
   2. Individual tumor \> 5cm
   3. AFP \> 400 ug/L
   4. MVI positive based on preoperative MRI according to MVI predictive model of Radiomics
5. Measurable or evaluable lesions according to RECIST v1.1 criteria
6. ECOG performance status 0-1
7. Child-Pugh class A
8. Life expectancy ≥ 12 weeks
9. Adequate organ and marrow function as defined below:

   1. Hemoglobin ≥9.0 g/dL
   2. Absolute neutrophil count ≥ 1,500/μL
   3. Platelets count ≥ 75,000/μL
   4. Total serum bilirubin ≤ 1.5 ×upper limit of normal(ULN)
   5. AST and ALT ≤ 5 × ULN, ALP ≤ 4 ×ULN
   6. Serum creatinine ≤ 1.5 ×ULN
   7. INR ≤ 1.5 ×ULN, APTT ≤ 1.5 ×ULN
   8. Serum albumin ≥3.0 g/dL
10. Women of childbearing potential (WOCBP) must have a negative serum or urine pregnancy test.
11. Patients with a prior or concurrent malignancy whose natural history or treatment does not have the potential to interfere with the safety or efficacy assessment of the investigational regimen as assessed by the treating investigator are eligible for this trial.
12. Ability to understand and the willingness to sign a written informed consent document.

Exclusion Criteria:

1. Any prior treatment for HCC.
2. Tumor rupture or bleeding. Suspected abdominal metastasis.
3. A major surgical procedure, open biopsy, or significant traumatic injury with poorly healed wound within 6 weeks prior to enrollment.
4. History of allogenic organ transplantation.
5. Under other clinical trials.
6. Active or prior documented autoimmune or inflammatory disorders (including inflammatory bowel disease \[e.g., colitis or Crohn's disease\], diverticulitis \[with the exception of diverticulosis\], systemic lupus erythematosus, Sarcoidosis syndrome, or Wegener syndrome \[granulomatosis with polyangiitis, Graves' disease, rheumatoid arthritis, hypophysitis, uveitis, etc.\]). The following are exceptions to this criterion: vitiligo or alopecia, hypothyroidism (e.g., following Hashimoto syndrome) stable on hormone replacement, any chronic skin condition that does not require systemic therapy or celiac disease controlled by diet alone.
7. History of allergic reactions attributed to compounds of similar chemical or biologic composition to AK104 or other immune checkpoint inhibitors.
8. Uncontrolled intercurrent illness, including but not limited to, ongoing or active infection (including tuberculosis), uncontrolled hypertension (defined as blood pressure of \> 140/90 mmHg during the screening period despite medical management), interstitial lung disease, serious chronic gastrointestinal conditions associated with diarrhea, or psychiatric illness/social situations that would limit compliance with study requirement, substantially increase risk of incurring AEs, or compromise the ability of the patient to give written informed consent.
9. History of hepatic encephalopathy, refractory ascites or esophagogastric varices with high risk of bleeding. Upper gastrointestinal hemorrhage within the year prior to the first dose of study drug.
10. Active hepatitis B infection without treatment (positive HBV surface antigen (HBsAg) and HBV DNA ≥ 1000 IU/ml). Patients with a past or resolved HBV infection (defined as the presence of hepatitis B core antibody \[anti-HBc\] and absence of HBsAg) are eligible. Active hepatitis C infection (positive HCV antibody and HCV RNA above the lower limit of detection).
11. A primary brain tumor (excluding meningiomas and other benign lesions), any brain metastases, leptomeningeal disease, seizure disorders not controlled with standard medical therapy, or history of a stroke within the year prior to the first dose of study drug.
12. History of active primary immunodeficiency.
13. History of testing positive for human immunodeficiency virus (HIV) or known acquired immunodeficiency syndrome (AIDS)
14. Current or prior use of immunosuppressive medication within 14 days prior to the first dose of study agent. The following are exceptions to this criterion: Intranasal, inhaled, topical steroids, or local steroid injections (e.g., intra-articular injection). Systemic corticosteroids at physiologic doses that do not exceed 10 mg/day of prednisone or its equivalent. Steroids as premedication for hypersensitivity reactions (e.g., CT scan premedication).
15. Receipt of live attenuated vaccine within 30 days prior to the first dose of study drug. Note: Patients, if enrolled, should not receive live vaccine whilst receiving study drug and for at least 30 days after the last dose of study agent.
16. Systemic immunostimulant therapy within 14 days prior to the first dose of study agent.
17. History of serious systemic disease, including myocardial infarction or unstable angina within the 12 months prior to the first dose of study drug, hypertensive crisis or hypertensive encephalopathy, New York Heart Association (NYHA) grade II or greater congestive heart failure, unstable symptomatic arrhythmia requiring medication, significant vascular disease or symptomatic peripheral vascular disease.
18. History of coagulopathy, bleeding diathesis, or thrombosis within the 12 months prior to the first dose of study drug.
19. A serious, non-healing wound, ulcer, or bone fracture.
20. Pregnancy or lactation.
21. Total parenteral nutrition.
22. Exclusion from the study by the judgement of investigators, due to some factors that may lead to the forced termination of the study, including other acute, chronic or psychological disease.

Where this trial is running

Guangzhou, Guangdong

• The first affiliated hospital of SYSU — Guangzhou, Guangdong, China (RECRUITING)

Study contacts

• Study coordinator: Ming Kuang, Doctor

Conditions: Resectable Hepatocellular Carcinoma With High Risk of Recurrence, Resectable Hepatocellular Carcinoma with High Risk of Recurrence, Real-world study