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Comparative efficacy and safety of systemic therapy for advanced hepatocellular carcinoma: a systematic review and network meta-analysis.
Wu, Di; Jia, Binyang; Jia, Muyuan; Zhao, Haitao; Zhao, Hong; Zhou, Jinxue.
Afiliación
  • Wu D; Department of Otolaryngology, Head and Neck Surgery, Graduate College of Youjiang Medical University for Nationalities, Baise, Guangxi Zhuang, China.
  • Jia B; Department of Hepatobiliary and Pancreatic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, China.
  • Jia M; Department of Neuro-Oncology, Beijing Arion Cancer Center, Beijing, China.
  • Zhao H; Department of Liver Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
  • Zhao H; Department of Hepatobiliary Surgery, National Cancer Centre/National Clinical Research Centre for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
  • Zhou J; Department of Hepatobiliary and Pancreatic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, China.
Front Oncol ; 13: 1274754, 2023.
Article en En | MEDLINE | ID: mdl-38125936
ABSTRACT

Background:

In recent years, there has been rapid development in systemic therapeutic agents for advanced hepatocellular carcinoma. However, most treatment modalities lack head-to-head comparisons, and the distinctions in their efficacy and safety have yet to be elucidated. Consequently, the accurate selection of a treatment regimen poses a significant challenge for clinicians.

Methods:

This study incorporated twenty-three randomized controlled trials, encompassing fifteen first-line and eight second-line treatments, and involving a total of 14,703 patients with advanced hepatocellular carcinoma.

Results:

In the context of first-line treatment, it was observed that the combination of a PD-1 inhibitor with bevacizumab (1/15) significantly extended overall survival in patients with advanced HCC. Furthermore, PD-1 inhibitors combined with TKIs (1/15) and PD-1 inhibitors combined with bevacizumab (2/15) exhibited enhanced efficacy in reducing the risk of progression-free survival events. In second-line therapy, the network meta-analysis revealed that all investigational agents prolonged progression-free survival in patients with advanced hepatocellular carcinoma when compared to placebo. Cabozantinib ranked first (1/7) in this regard. However, this translated into an overall survival benefit only for cabozantinib, regorafenib, ramucirumab, and pembrolizumab, with regorafenib achieving the highest ranking (1/7).

Conclusion:

In the treatment of advanced HCC, the immune checkpoint inhibitor combined with bevacizumab regimen and the immune checkpoint inhibitor combined with TKI regimen stand out as the two most effective first-line treatment options. It is noteworthy that, for patients with absolute contraindications to VEGF inhibitors, dual immunotherapy is the preferred choice. For second-line treatment, regorafenib and cabozantinib are identified as the two most effective options. Systematic review registration https//www.crd.york.ac.uk/prospero, identifier CRD42023440173.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Tipo de estudio: Systematic_reviews Idioma: En Revista: Front Oncol Año: 2023 Tipo del documento: Article País de afiliación: China Pais de publicación: Suiza
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Tipo de estudio: Systematic_reviews Idioma: En Revista: Front Oncol Año: 2023 Tipo del documento: Article País de afiliación: China Pais de publicación: Suiza