Intraarterial Therapies Plus Tislelizumab Plus Lenvatinib Versus Tislelizumab Plus Gemcitabine-Cisplatin in Unresectable Intrahepatic Cholangiocarcinoma

This is a phase III, multicenter, open-label, randomized controlled trial designed to evaluate the efficacy and safety of arterially directed therapy in combination with tislelizumab plus lenvatinib compared with gemcitabine and cisplatin (GEMCIS) in combination with tislelizumab as first-line treatment for patients with unresectable intrahepatic cholangiocarcinoma. Approximately 140 eligible patients with histologically confirmed unresectable intrahepatic cholangiocarcinoma without extrahepatic metastasis will be enrolled and randomized in a 1:1 ratio to receive either TACE plus tislelizumab and lenvatinib or GEMCIS plus tislelizumab. In the TACE-based treatment arm, hepatic arterial infusion chemotherapy with gemcitabine and cisplatin may be administered during or after TACE at the investigator's discretion according to the protocol. The primary endpoint is overall survival. Secondary endpoints include progression-free survival, time to progression, objective response rate, disease control rate, safety, and quality of life.

Inclusion Criteria: 1. Age ≥18 years. 2. Histologically confirmed intrahepatic cholangiocarcinoma that is unresectable or recurrent after curative treatment, without extrahepatic metastasis. 3. No prior systemic therapy or transarterial interventional therapy for intrahepatic cholangiocarcinoma. 4. At least one measurable intrahepatic lesion according to RECIST v1.1. 5. ECOG performance status of 0 or 1. 6. Child-Pugh class A liver function. 7. Life expectancy ≥3 months. 8. Adequate hematologic, hepatic, renal, and thyroid function within 14 days before study start, defined as: * Absolute neutrophil count ≥1.5 × 10⁹/L; * Platelet count ≥75 × 10⁹/L; * Hemoglobin ≥90 g/L; * Serum albumin ≥30 g/L; * Total bilirubin ≤1.5 × upper limit of normal; * AST and ALT \