Advances in transarterial chemoembolization for hepatocellular carcinoma: Integration with systemic therapies and emerging treatment strategies

Hepatocellular carcinoma (HCC) remains a leading cause of cancer-related mortality worldwide, posing considerable challenges due to its complex progression and limited curative options. Transarterial chemoembolization (TACE) is a cornerstone treatment for intermediate-stage HCC, as outlined in widely accepted clinical guidelines, including the Barcelona Clinic Liver Cancer (BCLC) framework. Over the years, TACE has evolved through technological innovations and novel therapeutic combinations designed to enhance efficacy and improve patient outcomes. Recent advancements include refined imaging techniques, innovative embolic materials, and the integration of systemic therapies such as tyrosine kinase inhibitors and immune checkpoint inhibitors. These developments have not only broadened the applicability of TACE but also enhanced its effectiveness in controlling tumor progression and extending survival in patients with unresectable disease. Despite these advancements, challenges persist, including the optimization of treatment protocols, the management of complications, and the need for personalized therapy tailored to diverse patient populations. This review highlights the latest progress and current understanding of TACE as a therapeutic modality for HCC. It also explores emerging trends, ongoing challenges, and the potential for novel combinations to redefine the therapeutic landscape. By synthesizing the latest evidence, this article aims to provide valuable insights for clinicians and researchers striving to improve HCC management and patient outcomes.