肝动脉灌注化疗联合乐伐替尼和PD-1抑制剂与乐伐替尼和PD-1抑制剂治疗不可切除肝细胞癌的Meta分析

Hepatic arterial infusion chemotherapy combined with lenvatinib and PD-1 inhibitors versus lenvatinib and PD-1 inhibitors for unresectable HCC: a meta-analysis.

作者信息

Wei Min, Zhang Pengwei, Yang Chaofeng, Li Yang

机构信息

Sichuan Key Laboratory of Medical Imaging, Department of Radiology, The Affiliated Hospital of North Sichuan Medical College, Nanchong, China.

出版信息

Front Oncol. 2024 Dec 24;14:1500496. doi: 10.3389/fonc.2024.1500496. eCollection 2024.

OBJECTIVES

This study aimed to evaluate the effectiveness of combining hepatic arterial infusion chemotherapy (HAIC) with lenvatinib and programmed cell death protein 1 (PD-1) inhibitors in the treatment of advanced, unresectable hepatocellular carcinoma (HCC).

METHODS

A comprehensive search across multiple databases was conducted to identify relevant studies published up to May 2024. This search focused on clinical trials investigating the combination of HAIC with lenvatinib and PD-1 inhibitors for the treatment of advanced HCC. Data from these trials were analyzed using either fixed-effects or random-effects models, with results reported as hazard ratios (HRs) or risk ratios (RRs) with 95% confidence intervals (CIs). To evaluate the robustness of the findings, trial sequential analysis was employed.

RESULTS

A total of 8 cohort studies encompassing 1073 patients with unresectable HCC were included. Compared with other treatment regimens, the combined use of HAIC, lenvatinib, and PD-1 inhibitors significantly improved overall survival (OS) (HR=0.53 [95% CI 0.45, 0.63], P<0.00001), progression-free survival (PFS) (HR 0.56 [95% CI 0.46, 0.61], P<0.0001), the objective response rate (ORR) (RR=1.82 [95% CI 1.52, 2.18], P<0.00001), and the disease control rate (DCR) (RR=1.24 [95% CI 1.16, 1.33], P<0.00001). Trial sequential analysis (TSA) results indicated that the existing data were sufficient for making quantitative conclusions about the ORR and DCR.

CONCLUSION

Combining HAIC with lenvatinib and PD-1 inhibitors enhances the effectiveness of treatment for unresectable HCC. This approach is particularly beneficial for patients who have a high tumor burden or those who are refractory to transarterial chemoembolization (TACE), providing a more effective solution for these challenging cases.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024575853, identifier CRD42024575853.

目的

本研究旨在评估肝动脉灌注化疗（HAIC）联合乐伐替尼及程序性细胞死亡蛋白1（PD - 1）抑制剂治疗晚期不可切除肝细胞癌（HCC）的有效性。

方法

对多个数据库进行全面检索，以识别截至2024年5月发表的相关研究。该检索聚焦于调查HAIC联合乐伐替尼及PD - 1抑制剂治疗晚期HCC的临床试验。使用固定效应或随机效应模型分析这些试验的数据，结果以风险比（HRs）或比值比（RRs）及95%置信区间（CIs）报告。为评估研究结果的稳健性，采用了试验序贯分析。

结果

共纳入8项队列研究，涉及1073例不可切除HCC患者。与其他治疗方案相比，HAIC、乐伐替尼及PD - 1抑制剂联合使用显著改善了总生存期（OS）（HR = 0.53 [95% CI 0.45, 0.63]，P < 0.00001）、无进展生存期（PFS）（HR 0.56 [95% CI 0.46, 0.61]，P < 0.0001）、客观缓解率（ORR）（RR = 1.82 [95% CI 1.52, 2.18]，P < 0.00001）及疾病控制率（DCR）（RR = 1.24 [95% CI 1.16, 1.33]，P < 0.00001）。试验序贯分析（TSA）结果表明，现有数据足以对ORR和DCR得出定量结论。