Efficacy and safety of radiotherapy combined with immune checkpoint inhibitors for advanced or unresectable hepatocellular carcinoma: A systematic review and meta-analysis

IF 5.5 2区医学 Q1 HEMATOLOGY

Critical reviews in oncology/hematology Pub Date : 2025-04-14 DOI:10.1016/j.critrevonc.2025.104730

Qibin Wu , Xia Zhao , Chong Yang , Yinglin Yuan , Hongji Yang , Qiang Fu

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Abstract

Background

To evaluate the efficacy and safety of radiotherapy with immune checkpoint inhibitors (ICIs), with or without anti-vascular endothelial growth factor (anti-VEGF) agents, in the treatment of advanced or unresectable hepatocellular carcinoma (HCC).

Methods

Databases including Web of Science, PubMed, Embase, Cochrane Library databases, American Society of Clinical Oncology, and European Society for Medical Oncology were systematically searched. The search included publications up to August 31, 2024. Primary outcome measures included objective response rate (ORR), disease control rate (DCR), incidence of treatment-related adverse events (TRAEs), and TRAEs (grade ≥3).

Results

Twenty-one articles were included in this study (927 participants). Following RECIST 1.1, for external radiotherapy combined with ICIs, the ORR and DCR were 56 % (95 % CI 0.48–0.64, I²=65.91 %) and 88 % (95 % CI 0.77–0.96, I²=87.19 %), respectively; for yttrium-90 combined with ICI, they were 31 % (95 %CI 0.20–0.43, I²=0 %) and 73 % (95 %CI 0.48–0.92, I²=75.23 %), respectively. According to CTCAE criteria, for external radiotherapy combined with ICIs, the incidence of TRAEs (all grades) was 95 % (95 % CI 0.89–0.98, I²=70.79 %), and the incidence of TRAEs (grades ≥3) was 35 % (95 % CI 0.23–0.48, I²=87.54 %); for yttrium-90 combined with ICIs, they were 78 % (95 %CI 0.48–0.98, I²=88.15 %) and 22 % (95 %CI 0.04–0.47, I²=83.69 %), respectively. Subgroup analyses indicated that sequential therapy demonstrated a higher DCR than concurrent therapy, while the combination of intensity-modulated radiotherapy, ICIs, and anti-VEGF agents showed improved efficacy but was associated with increased toxicity.

Conclusions

Radiotherapy combined with ICI demonstrates substantial efficacy and manageable safety in advanced or unresectable HCC. Sequential therapy may enhance therapeutic effectiveness while reducing TRAEs.

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放疗联合免疫检查点抑制剂治疗晚期或不可切除肝细胞癌的疗效和安全性：一项系统综述和荟萃分析

研究背景：评价免疫检查点抑制剂（ICIs）联合或不联合抗血管内皮生长因子（anti-VEGF）治疗晚期或不可切除的肝细胞癌（HCC）的疗效和安全性。方法系统检索Web of Science、PubMed、Embase、Cochrane Library数据库、美国临床肿瘤学会（American Society of Clinical Oncology）和欧洲肿瘤医学学会（European Society for Medical Oncology）数据库。搜索包括截至2024年8月31日的出版物。主要结局指标包括客观缓解率（ORR）、疾病控制率（DCR）、治疗相关不良事件发生率（TRAEs）和TRAEs（分级≥3）。结果共纳入21篇文献（927名受试者）。RECIST 1.1后，外部放疗联合ICIs的ORR和DCR分别为56 %（95 % CI 0.48-0.64, I2=65.91 %）和88 %(95 % CI 0.77-0.96, I2=87.19 %)；钇-90联合ICI分别为31 %（95 %CI 0.20 ~ 0.43, I2=0 %）和73 %（95 %CI 0.48 ~ 0.92, I2=75.23 %）。根据CTCAE标准，外放疗联合ICIs的TRAEs（所有分级）发生率为95 %(95 % CI 0.89-0.98, I2=70.79 %),TRAEs（分级≥3）发生率为35 %(95 % CI 0.23-0.48, I2=87.54 %)；钇-90联合ICIs分别为78 %（95 %CI 0.48 ~ 0.98, I2=88.15 %）和22 %（95 %CI 0.04 ~ 0.47, I2=83.69 %）。亚组分析表明，顺序治疗的DCR高于同期治疗，而调强放疗、ICIs和抗vegf药物联合治疗的疗效有所改善，但毒性增加。结论放疗联合ICI治疗晚期或不可切除的HCC疗效显著，安全性可控。序贯治疗可提高治疗效果，同时降低trae。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Critical reviews in oncology/hematology 医学-血液学

CiteScore

11.00

自引率

3.20%

发文量

213

审稿时长

55 days

期刊介绍： Critical Reviews in Oncology/Hematology publishes scholarly, critical reviews in all fields of oncology and hematology written by experts from around the world. Critical Reviews in Oncology/Hematology is the Official Journal of the European School of Oncology (ESO) and the International Society of Liquid Biopsy.