Although the mechanisms of resistance to lenvatinib-TACE are still unknown (Shimose et al. 2020), an explanation as to why a better survival benefit is observed with pembrolizumab is that lenvatinib-TACE forms a beneficial tumour-immune microenvironment, partially through blocking immunosuppressive vascular endothelial growth factor (VEGF) signalling (Kawamura et al. 2020); thus, the earlier pembrolizumab is applied, the greater the survival benefit may be for these individuals (Llovet et al. 2020; Zhu et al. 2018). Here, VEGFA is linked to neoplasm.