Updated Network Meta-Analysis of First-Line Systemic Treatments for Advanced HCC: Consistent Role of TACE.

IF 11.6 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY
Liver Cancer Pub Date : 2025-06-12 DOI:10.1159/000546697
Ye Rim Kim, Euichang Kim, Ha Il Kim, Seungbong Han, Jihyun An, Ju Hyun Shim
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引用次数: 0

Abstract

Background and aims: We conducted an updated network meta-analysis to evaluate and identify the optimal first-line treatment for advanced hepatocellular carcinoma (HCC) among all relevant interventional and targeted therapies.

Methods: We analyzed 16 phase 2 or 3 randomized controlled trials involving 9,482 patients with metastatic or unresectable HCC published between 2018 and 2024. The trials evaluated 11 systemic agents and 5 interventional treatments in combination with systemic therapy, using either sorafenib or lenvatinib as the control. The primary outcome was overall survival (OS), and secondary outcomes included progression-free survival (PFS) and grade 3-4 adverse events. Subgroup analyses were conducted to assess individual treatment efficacies in specific clinical settings.

Results: Transarterial chemoembolization (TACE) combined with lenvatinib provided the greatest improvement in OS over sorafenib, with a hazard ratio of 0.41 (95% confidence interval, 0.30-0.58), followed by sintilimab + IBI305 (0.57; 0.43-0.75), camrelizumab + rivoceranib (0.62; 0.48-0.80), atezolizumab + bevacizumab (0.66; 0.51-0.85), lenvatinib + pembrolizumab (0.77; 0.62-0.97), and tremelimumab + durvalumab (0.78; 0.64-0.95). These combinations, except for tremelimumab + durvalumab, also showed significantly superior PFS to sorafenib. TACE + lenvatinib was ranked first in OS analyses with the other current standard-of-care regimens (lenvatinib, atezolizumab + bevacizumab, and tremelimumab + durvalumab) as controls. TACE + lenvatinib, sintilimab + IBI305, and atezolizumab + bevacizumab demonstrated consistently significant extension of OS over sorafenib in subsets with portal invasion, extrahepatic metastasis, and hepatitis B. All immunotherapy-based combinations were significantly associated with a higher risk of adverse events than sorafenib.

Conclusions: For advanced HCC, our first-line analysis consistently scored TACE + lenvatinib the best for survival outcomes, followed by various immunotherapy-based combinations. However, the superior efficacy of TACE + lenvatinib should be interpreted with consideration of its derivation from a region with high hepatitis B virus prevalence.

晚期HCC一线全身治疗的最新网络荟萃分析:TACE的一致作用。
背景和目的:我们进行了一项最新的网络荟萃分析,以评估和确定所有相关介入和靶向治疗中晚期肝细胞癌(HCC)的最佳一线治疗方法。方法:我们分析了2018年至2024年间发表的16项2期或3期随机对照试验,涉及9482例转移性或不可切除的HCC患者。试验评估了11种全身药物和5种介入治疗联合全身治疗,使用索拉非尼或lenvatinib作为对照。主要终点是总生存期(OS),次要终点包括无进展生存期(PFS)和3-4级不良事件。进行亚组分析以评估特定临床环境下的个体治疗效果。结果:经动脉化疗栓塞(TACE)联合lenvatinib比sorafenib提供了最大的OS改善,风险比为0.41(95%可信区间为0.30-0.58),其次是sintilmab + IBI305 (0.57;0.43-0.75), camrelizumab + rivoeranib (0.62;0.48-0.80), atezolizumab + bevacizumab (0.66;0.51-0.85), lenvatinib + pembrolizumab (0.77;0.62-0.97), tremelimumab + durvalumab (0.78;0.64 - -0.95)。除tremelimumab + durvalumab外,这些组合也显示出明显优于索拉非尼的PFS。TACE + lenvatinib在OS分析中排名第一,其他现行标准治疗方案(lenvatinib, atezolizumab + bevacizumab和tremelimumab + durvalumab)作为对照。TACE + lenvatinib、sintilimab + IBI305和atezolizumab + bevacizumab在门静脉侵入、肝外转移和乙型肝炎的亚群中显示出比索拉非尼持续显著延长OS。所有基于免疫治疗的组合都比索拉非尼具有更高的不良事件风险。结论:对于晚期HCC,我们的一线分析一致认为TACE + lenvatinib对生存结果最好,其次是各种基于免疫治疗的组合。然而,在解释TACE + lenvatinib的优越疗效时,应考虑到其来自乙型肝炎病毒高流行地区。
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
Liver Cancer
Liver Cancer Medicine-Oncology
CiteScore
20.80
自引率
7.20%
发文量
53
审稿时长
16 weeks
期刊介绍: Liver Cancer is a journal that serves the international community of researchers and clinicians by providing a platform for research results related to the causes, mechanisms, and therapy of liver cancer. It focuses on molecular carcinogenesis, prevention, surveillance, diagnosis, and treatment, including molecular targeted therapy. The journal publishes clinical and translational research in the field of liver cancer in both humans and experimental models. It publishes original and review articles and has an Impact Factor of 13.8. The journal is indexed and abstracted in various platforms including PubMed, PubMed Central, Web of Science, Science Citation Index, Science Citation Index Expanded, Google Scholar, DOAJ, Chemical Abstracts Service, Scopus, Embase, Pathway Studio, and WorldCat.
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