Department of Hematology-Oncology, Inha University College of Medicine and Hospital, 7-206 Third Street, Shinheung-dong Jung-gu, Incheon, Republic of Korea.
Target Oncol. 2019 Aug;14(4):395-403. doi: 10.1007/s11523-019-00651-7.
Several clinical trials that tested the efficacy of systemic treatments for advanced hepatocellular carcinoma (HCC) showed a tendency that patients with hepatitis B virus (HBV) and hepatitis C virus (HCV) infection had different survival benefits from targeted agents.
The objective of this study was to assess the comparative efficacy of systemic targeted therapies according to HBV and HCV status in first-line and second- or later-line treatments for advanced HCC.
PubMed, EMBASE, Cochrane database, and meeting abstracts were searched through to January 2019. A Bayesian network meta-analysis was performed to estimate hazard ratios (HRs) for overall survival with 95% credible intervals (CrIs) and determine the ranking of the included regimens.
Sixteen trials involving 6410 patients were included in the meta-analysis. In the first-line treatment setting, lenvatinib was the best agent for both HBV and HCV subgroups, presenting the most favorable HR versus sorafenib (HR 0.83, 95% CrI 0.68-1.01 and HR 0.91, 95% CrI 0.66-1.25, respectively), and was ranked as the best agent [surface under the cumulative ranking curve (SUCRA) value of 87% and 85%, respectively] among the included drugs. In second-line therapy, regorafenib showed the lowest HR versus placebo (HR 0.58, 95% CrI 0.41-0.82) in the HBV subgroup, whereas no agent was significantly more effective than placebo in the HCV subgroup.
Compared with sorafenib, lenvatinib was more efficacious in the HBV subgroup than in the HCV subgroup, and the relative ranking of sorafenib in the HBV subgroup was lower than in the HCV subgroup. Each targeted agent reported to be the best by viral etiology and line of treatment could be carefully recommended in each subgroup.
几项针对晚期肝细胞癌（HCC）系统治疗疗效的临床试验表明，乙型肝炎病毒（HBV）和丙型肝炎病毒（HCV）感染的患者从靶向药物中获益的生存情况不同。
本研究旨在评估根据 HBV 和 HCV 状态，在晚期 HCC 的一线和二线或更后线治疗中，系统靶向治疗的比较疗效。
检索了PubMed、EMBASE、Cochrane 数据库和会议摘要，检索时间截至 2019 年 1 月。采用贝叶斯网络荟萃分析来估计总生存的风险比（HRs）及其 95%可信区间（CrIs），并确定纳入方案的排序。
共有 16 项临床试验纳入了 6410 例患者的荟萃分析。在一线治疗中，仑伐替尼在 HBV 和 HCV 亚组中均为最佳药物，与索拉非尼相比，具有更有利的 HR（HR 0.83，95%CrI 0.68-1.01 和 HR 0.91，95%CrI 0.66-1.25），在纳入的药物中排名第一[累积排序曲线下面积（SUCRA）值分别为 87%和 85%]。在二线治疗中，regorafenib 在 HBV 亚组中与安慰剂相比 HR 最低（HR 0.58，95%CrI 0.41-0.82），而在 HCV 亚组中，没有一种药物比安慰剂更有效。
与索拉非尼相比，仑伐替尼在 HBV 亚组中的疗效优于 HCV 亚组，且在 HBV 亚组中索拉非尼的相对排名低于 HCV 亚组。根据病毒病因学和治疗线，每个被报道为最佳的靶向药物都可以在每个亚组中被谨慎推荐。
