Abstract: Objective To explore the efficacy and safety of different doses of apatinib combined with karelizumab in the treatment of advanced liver cancer. Methods Sixty-eight patients with advanced hepatocellular carcinoma admitted from October 2017 to October 2020 in Xuancheng Central Hospital were divided into a high-dose group and a low-dose group with 34 patients in each group. On the basis of 200 mg/time of intravenous infusion of carelizumab, the low-dose group and high-dose group took additional 250 mg/d and 500 mg/d of alpatinib mesylate tablets respectively. The Objective remission rate, adverse reaction rate and 2-year overall survival rate of the two groups after 1 month of treatment were recorded. Results The Objective response rate of the high-dose group was 67.65%, which was higher than that of the low-dose group (41.18%, P<0.05); The difference of disease control rate between the two groups was not statistically significant (P>0.05). The incidence of renal proteinuria and hand-foot syndrome was higher in the high-dose group (P<0.05). The median total survival (OS) was 13 months and 17 months in the low-dose group and high-dose group, and the median progression-free survival (PFS) was 8 months and 9 months, respectively. The total 2-year survival rate was 31.25% and 45.45%, respectively. There was statistically significant difference in PFS curve between the two groups (P<0.05). Conclusion In the treatment of advanced primary hepatocellular carcinoma, appropriately increasing the dosage of apatinib mayl help to improve the efficacy, but the risk of adverse reactions such as renal proteinuria and hand-foot syndrome will be a major concern.

Key words: Hepatocellular carcinoma, Advanced, Apatinini, Carrelizumab