Efficacy of Different Treatments for Patients with Advanced Hepatocellular Carcinoma: A System Review and Network Meta-Analysis

Abstract

<strong>Background:</strong> Over the past decade, the treatment landscape for advanced hepatocellular carcinoma (HCC) has expanded considerably. Therefore, this network meta-analysis aimed to compare the efficacy of combination treatment versus sorafenib. <strong>Materials and Methods:</strong> A systematic literature review was conducted to select eligible studies. A network meta-analysis was performed to compare the overall survival (OS) and objective response rate (ORR) among anti- programmed death 1 (PD-1)/programmed cell death ligand 1 (PD-L1) plus anti-vascular endothelial growth factor (VEGF), hepatic arterial infusion chemotherapy (HAIC) plus sorafenib and sorafenib in patients with advanced HCC. Furthermore, for patients without extrahepatic spread, the comparison of the OS among transarterial chemoembolization (TACE) plus radiotherapy (RT), anti-PD-1/PD-L1 plus anti-VEGF, HAIC plus sorafenib and sorafenib was conducted. <strong>Results:</strong> A total of 1182 articles were screened through database searching, among which 7 studies involving 1639 patients were included in the analysis. By comparison of 6-month OS, 12-month OS and ORR, anti-PD-1/PD-L1+anti-VEGF was considered the best intervention in advanced HCC anti-PD-1/PD-L1 plus anti-VEGF versus sorafenib: 12-month OS: HR, 0.64; 95% CI, 0.47–0.88; ORR: odd ratio, 0.53; 95% CI, 0.38–0.74). While for patients without extrahepatic spread, the above four interventions showed similar OS; however, TACE plus RT rank the best with a P-score of 57.07%. <strong>Conclusions:</strong> In patients with advanced HCC, anti-PD-1/PD-L1+anti-VEGF was associated with highest ranking of OS compared with HAIC plus sorafenib and sorafenib. TACE plus RT might be a more favorable choice than other treatments in advanced HCC without extrahepatic spread. <strong>Highlights:</strong> <ul><li>The treatment landscape for advanced hepatocellular carcinoma (HCC) has expanded considerably over the last decade. This network meta-analysis was conducted to compare the efficacy of combination treatment versus sorafenib.</li><li>Based on the findings, anti-PD-1/PD-L1+anti-VEGF was considered the best intervention in advanced HCC via comparison of 6-month OS and 12-month OS.</li><li>In patients without extrahepatic metastases, TACE plus RT and anti-PD-1/PD-L1 plus anti-VEGF yielded similar outcomes for advanced HCC without extrahepatic spread in OS.</li><li>The analysis presented that anti-PD-1/PD-L1 plus anti-VEGF ranked the highest on P-score in terms of ORR.</li><li>TACE plus RT rank the best with a P-score of 57.07% in overall survival compared with anti-PD-1/PD-L1 plus anti-VEGF and HAIC plus sorafenib.</li><li>Future studies could focus on the role of radiation and other potential combinations.</li></ul>