AIM: To investigate the efficacy and safety of checkpoint inhibitor lenvatinib combined with Tirelizumab in the treatment of advanced hepatocellular carcinoma (HCC). METHODS: A retrospective analysis was performed on 52 patients with advanced HCC treated with Renvatinib, tirellizumab or their combination from January 2021 to December 2022 in Zhongda Hospital Affiliated to Southeast University, with disease progression, death and intolerance as endpoints. Efficacy was assessed according to RECIST 1.1 criteria and follow-up was conducted up to June 2023. The main endpoints of the study were objective response rate (ORR), disease control rate (DCR), progression-free survival, PFS) and security. RESULTS: The combination therapy significantly improved ORR and mPFS in patients compared with tirelizumab or lenvatinib monotherapy. Compared with single tirellizumab or lenvastinib, there was no significant difference in the adverse reactions associated with the combination treatment, suggesting that the combination of the two was generally well tolerated and the side effects are controllable. CONCLUSION: Lonvastinib combined with tirelizumab is more effective in the treatment of HCC, can significantly prolong PFS, and is generally well tolerated, which may be a potential treatment for advanced HCC.