Abstract
Background
Programmed death-1 inhibitors plus lenvatinib and transarterial chemoembolization (TACE) (P–L–T) is a novel combination strategy. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of P–L–T compared with lenvatinib and TACE (L–T) therapy in patients with unresectable hepatocellular carcinoma.
Methods
A systematic literature search of the PubMed, Embase, Web of Science and Cochrane Library databases for studies investigating P–L–T therapy was performed. Data regarding outcome data, including overall survival (OS), progression-free survival (PFS), tumor response, and adverse events (AEs), were independently extracted by two authors using a standardized protocol.
Results
Eight cohort studies comprising 847 patients (P–L–T: 416, L–T: 431) were included in the meta-analysis. The P–L–T group exhibited significantly longer OS (hazard ratio (Page et al.) 0.51 [95% confidence interval (CI) 0.42–0.62]; I2 = 9.8%; p = 0.354] and PFS (HR 0.51 [95% CI 0.43–0.61]; I2 = 0%; p = 0.824), and higher objective response rate (risk ratio [RR] 1.54 [95% CI 1.33–1.78]; I2 = 0%, p = 0.858]) and disease control rate (RR 1.27 [95% CI 1.17–1.38]; I2 = 17.3%; p = 0.467). Grade 3/4 AEs were more prevalent in the P–L–T group, including hypertension (RR 1.91 [95% CI 1.16–3.15]), vomiting or nausea (RR 2.29 [95% CI 1.01–5.19]), and hypothyroidism (RR 12.21 [95% CI 1.63–91.23]).
Conclusion
Compared with L–T combination therapy, P–L–T demonstrated a significant advantage in terms of OS, PFS, objective response rate, disease control rate, and manageable AEs.
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Data availability
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
Abbreviations
- TACE:
-
Transarterial chemoembolization
- PD-1:
-
Programmed death-1
- HCC:
-
Hepatocellular carcinoma
- P–L–T:
-
PD-1 inhibitors plus lenvatinib and TACE
- L–T:
-
Lenvatinib plus TACE
- ORR:
-
Objective response rate
- DCR:
-
Disease control rate
- OS:
-
Overall survival
- PFS:
-
Progression-free survival
- ICIs:
-
Immune checkpoint inhibitors
- TKIs:
-
Tyrosine kinase inhibitors
- AEs:
-
Adverse events
- RR:
-
Risk ratio
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Funding
This study was supported by the Bureau of Science and Technology Nanchong City (no. 22SXQT0052).
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All authors contributed to the study conception and design. Data collection was performed by JL and SW. Statistical analysis was performed by SW, LY and JY. Interpretation of data was performed by JY and DY. Drafted and revised the manuscript were performed by JL and PY. All authors read and approved the final manuscript.
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Liu, J., Wei, S., Yang, L. et al. Efficacy and safety of transarterial chemoembolization plus lenvatinib with or without programmed death-1 inhibitors in the treatment of unresectable hepatocellular carcinoma: a systematic review and meta-analysis. J Cancer Res Clin Oncol 149, 14451–14461 (2023). https://doi.org/10.1007/s00432-023-05231-x
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DOI: https://doi.org/10.1007/s00432-023-05231-x