Transarterial chemoembolization with or without multikinase inhibitors for patients with unresectable hepatocellular carcinoma : a systematic review and meta-analysis of randomized controlled trials
Copyright © 2023 Dong, Ge, Qu, Zhu, Wu, Wang, Wang and Li..
Background: Randomized 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.
Methods: In 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.
Results: A 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.
Conclusions: TACE+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.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:13 |
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| Enthalten in: |
Frontiers in oncology - 13(2023) vom: 15., Seite 1139025 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Dong, Han [VerfasserIn] |
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| Links: |
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| Themen: |
Combination therapy |
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| Anmerkungen: |
Date Revised 01.07.2023 published: Electronic-eCollection Citation Status PubMed-not-MEDLINE |
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| doi: |
10.3389/fonc.2023.1139025 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM358629284 |
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| 100 | 1 | |a Dong, Han |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Transarterial chemoembolization with or without multikinase inhibitors for patients with unresectable hepatocellular carcinoma |b a systematic review and meta-analysis of randomized controlled trials |
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| 500 | |a Citation Status PubMed-not-MEDLINE | ||
| 520 | |a Copyright © 2023 Dong, Ge, Qu, Zhu, Wu, Wang, Wang and Li. | ||
| 520 | |a Background: Randomized 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 | ||
| 520 | |a Methods: In 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 | ||
| 520 | |a Results: A 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 | ||
| 520 | |a Conclusions: TACE+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 | ||
| 650 | 4 | |a Systematic Review | |
| 650 | 4 | |a combination therapy | |
| 650 | 4 | |a meta-analysis | |
| 650 | 4 | |a multikinase inhibitor | |
| 650 | 4 | |a transarterial chemoembolization | |
| 650 | 4 | |a unresectable hepatocellular carcinoma | |
| 700 | 1 | |a Ge, Dongfang |e verfasserin |4 aut | |
| 700 | 1 | |a Qu, Biao |e verfasserin |4 aut | |
| 700 | 1 | |a Zhu, Ping |e verfasserin |4 aut | |
| 700 | 1 | |a Wu, Qibiao |e verfasserin |4 aut | |
| 700 | 1 | |a Wang, Tianyun |e verfasserin |4 aut | |
| 700 | 1 | |a Wang, Jue |e verfasserin |4 aut | |
| 700 | 1 | |a Li, Zheng |e verfasserin |4 aut | |
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