Recently, the relationship between the relative dose intensity (RDI) and efficacy was demonstrated for lenvatinib therapy in patients with advanced hepatocellular carcinoma (HCC), with a higher RDI of lenvatinib monotherapy indicating a higher efficacy. However, not every patient can tolerate a high RDI during the course of treatment; therefore, add‑on combination therapy may be necessary for patients requiring a low RDI. The addition of transarterial chemoembolization (TACE) to lenvatinib therapy improves clinical outcomes. Therefore, the aim of the present study was to compare the clinical outcomes of lenvatinib plus TACE (the LEN‑TACE group) with those of lenvatinib alone (the LEN group) in patients with unresectable HCC with a high‑ or low‑RDI. A total of 66 patients with advanced HCC were enrolled in the present retrospective study. Eligible patients were those who initiated lenvatinib monotherapy between April 2018 and September 2020. Of these patients, 29 had an 8‑week RDI of ≥60%, 6 of which received LEN‑TACE. A further 37 patients had an 8‑week RDI of <60%, 7 of which received LEN‑TACE. In the high‑RDI group, both the radiological evaluations and the overall survival (OS) time were improved in those in the low‑RDI group. In addition, the median OS of patients treated with LEN‑TACE was longer compared with that of patients treated with lenvatinib alone in the low‑RDI group (P=0.0467). Therefore, the results of the present study revealed that early TACE should be considered instead of continuing lenvatinib only treatment in patients receiving an insufficient dose of lenvatinib, such as those with an 8‑week RDI of <60%.

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