FOLFOX-HAIC Plus Lenvatinib and Toripalimab vs. FOLFOX-HAIC Plus Lenvatinib for Advanced Hepatocellular Carcinoma: a Randomized Controlled and Double-blind Trial

Inclusion Criteria:

• The diagnosis of HCC was based on the diagnostic criteria for HCC used by the EuropeanAssociation for the Study of the Liver (EASL)
• Patients must have at least one tumor lesion that can be accurately measured accordingto EASL criteria.
• Barcelona clinic liver cancer-stage C
• Eastern Cooperative Oncology Group performance status of 0 to 2
• With no previous treatment
• No Cirrhosis or cirrhotic status of Child-Pugh class A only
• Not amendable to surgical resection ,local ablative therapy and any other curedtreatment.
• This study did not limit HBV DNA load. High HBV-DNA load was aollowed, but hepatitis-Bpatient must receive concurrent antiviral therapy.
• The following laboratory parameters: Hemoglobin ≥ 8.5 g/dL Total bilirubin ≤ 30mmol/L Serum albumin ≥ 30 g/L ASL and AST ≤ 5 xupper limit of normal Serum creatinine ≤ 1.5 x upper limit of normal INR ≤ 1.5 or PT/APTTwithin normal limits Absolute neutrophil count (ANC) >1,500/mm3

• Ability to understand the protocol and to agree to and sign a written informed consentdocument

Exclusion Criteria:

• Evidence of hepatic decompensation including ascites, gastrointestinal bleeding orhepatic encephalopathy
• Known history of HIV
• History of organ allograft
• Known or suspected allergy to the investigational agents or any agent given inassociation with this trial.
• Cardiac ventricular arrhythmias requiring anti-arrhythmic therapy
• Evidence of bleeding diathesis.
• Patients with clinically significant gastrointestinal bleeding within 30 days prior tostudy entry.
• Known central nervous system tumors including metastatic brain disease