Arterial chemotherapy in advanced hepatocellular carcinoma: An evolutionary trajectory exploration and pooled outcome analysis.

Abstract

e16125 Background: Hepatic artery infusion chemotherapy (HAIC) is widely used for the treatment of advanced hepatocellular carcinoma (HCC), particularly in East Asia. However, there have been inconsistent conclusions on the effectiveness of HAIC in previous studies, and the analysis landscape regarding relevant articles and clinical trials is lacking on this topic. We conducted a bibliometric analysis to explore the development of HAIC, and a pooled analysis using individual patient data to evaluate the outcomes of HAIC in advanced HCC. Methods: The Web of Science Core Collection was searched from its earliest records until October 2022, to identify studies associated with HAIC for advanced HCC. Relevant documents were collected and analyzed using R bibliometrix. During the same period, two international clinical trial registered platforms, ClinicalTrials.gov and ChiCTR.org, were searched for oxaliplatin-based HAIC utilization in HCC. A total of 845 patients treated with HAIC or its combination therapy from 17 pre-registered studies were analyzed to assess the overall survival (OS), progression-free survival (PFS), objective response rate (ORR per Response Evaluation Criteria in Solid Tumors (RECIST)), disease control rate (DCR per RECIST), and adverse events (AEs). Results: We identified 539 studies and derived the evolutionary trajectory of HAIC from the perspective of scientometry. Contributions of publications were presented at the country, institution, and author levels. Conversion therapy, Folfox, oxaliplatin and immunotherapy became new research foci. A total of 88 registered trials were identified and a comprehensive landscape of these trials was provided. Further interactive exploration of the trials was accessible through a HAICshiny application (https://sysucc.shinyapps.io/clinical-trial-of-HAIC-FO/). The OS was 13.7 months (95% confidence interval (CI) 12.2-15.3), and the corresponding times were 13.2, 13.8, 12.8, and 13.7 months in the cisplatin, oxaliplatin, HAIC monotherapy, and concomitant therapy subgroups, respectively. The corresponding PFS was 7.0 months (95% CI 6.5-7.8) in the whole cohort and 5.2, 7.7, 7.6, and 6.8 months in the subgroup cohorts. According to RECIST criteria, ORR and DCR reached 0.34 and 0.80, respectively. Comparable survival and tumor response were observed between the HAIC and its combination therapy groups. The incidence of AEs was identified, and most of them were manageable. Conclusions: This study illustrates the evolutionary trajectory of HAIC from the perspective of scientometry. The efficacy outcomes of HAIC in the treatment of advanced HCC were verified with manageable safety profiles. Further trials regarding HAIC implementation are emerging, and more effort is required to improve the quality of trials.