Transarterial chemoembolization with or without multikinase inhibitors for patients with unresectable hepatocellular carcinoma: a systematic review and meta-analysis of randomized controlled trials

Frontiers in Oncology

Oncology

Zheng Li¹  Biao Qu²  Ping Zhu³  Tianyun Wang⁴  Han Dong⁵  Dongfang Ge⁶  Qibiao Wu⁷  Jue Wang⁷ 

[1] College of Health Sciences, School of Life Sciences, Jiangsu Normal University, Xuzhou, China;State Key Laboratory of Natural and Biomimetic Drugs, Peking University, Beijing, China;Department of Clinical Pharmacology, The Second Hospital of Anhui Medical University, Hefei, China;Department of Endocrinology, Huaian Hospital of Huaian City, Huaian, China;Department of Endocrinology, Huaian Hospital of Huaian City, Huaian, China;Department of Pharmacy, Huaian Hospital of Huaian City, Huaian, China;Department of Nursing, Huaian Hospital of Huaian City, Huaian, China;President’s Office of Huaian Hospital of Huaian City, Huaian, China;State Key Laboratory of Quality Research in Chinese Medicines, Faculty of Chinese Medicine, Macau University of Science and Technology, Macau, Macau SAR, China;

关键词: transarterial chemoembolization;    multikinase inhibitor;    combination therapy;    unresectable hepatocellular carcinoma;    meta-analysis;   

DOI  :  10.3389/fonc.2023.1139025

 received in 2023-01-06, accepted in 2023-05-23,  发布年份 2023

来源: Frontiers

【 摘 要 】

BackgroundRandomized controlled trials (RCTs) testing the combination therapy of transarterial chemoembolization (TACE) plus multikinase inhibitor (MKI) in patients with unresectable hepatocellular carcinoma (HCC) have yielded inconsistent results.MethodsIn this work, a systematic review and meta-analysis was performed to compare the TACE+MKI combination therapy versus TACE monotherapy in HCC patients with time to progression (TTP) adopted as primary outcome.ResultsA total of 10 RCTs comprising 2837 patients receiving combination therapy (TACE plus sorafenib, brivanib, orantinib or apatinib) were included. TACE+MKI significantly prolonged TTP (hazard ratio [HR] 0.74, 95% CI 0.62-0.89, p=0.001) versus TACE monotherapy. Subgroup analysis suggested MKI administration before TACE might be preferable to post-TACE MKI for TTP. TACE+MKI also increased objective response rate (ORR) (risk ratio [RR] 1.17, 95% CI 1.03-1.32, p=0.01), but failed to improve overall survival (OS) (HR 0.98, 95% CI 0.86-1.13, p=0.82) and progression-free survival (PFS) (HR 0.75, 95% CI 0.50-1.12, p=0.16). The incidence of any adverse event (AE) did not significantly differ between TACE+MKI and TACE groups (RR 1.17, 95% CI 0.96-1.42, p=0.01), while serious AEs showed significant difference (RR 1.41, 95% CI 1.26-1.59, p<0.0001). Nevertheless, these AEs showing significant difference were mainly associated with MKI toxicities rather than TACE. ConclusionsTACE+MKI combination therapy improved TTP and ORR but not OS and PFS in patients with unresectable HCC. Further high-quality trials are needed to verify these clinical benefits, and our findings could be very informative for future trial design.

【 授权许可】

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Copyright © 2023 Dong, Ge, Qu, Zhu, Wu, Wang, Wang and Li