Hepatocellular carcinoma (HCC) remains one of the most prevalent and deadly malignancies worldwide. Despite advances in systemic therapies, long-term outcomes remain limited for many patients. Recently, combination strategies integrating targeted therapy and immunotherapy have demonstrated encouraging clinical benefits. Among them, the pairing of Lenvatinib with Anti-PD-1 therapy has emerged as a promising therapeutic approach. The Gut–Liver Axis in HCC The gut microbiome plays a pivotal role in maintaining metabolic balance, regulating inflammation, and modulating immune responses. In HCC, significant dysbiosis—an imbalance in microbial composition—has been observed. This disruption can contribute to chronic inflammation, altered bile acid metabolism, and impaired immune surveillance, all of which may promote tumor progression. Impact of Combination Therapy on Microbiota and Metabolism Treatment with lenvatinib combined with anti-PD-1 therapy appears to partially reverse HCC-associ...
