Sorafenib combined with transarterial chemoembolization in patients with hepatocellular carcinoma: a meta-analysis and systematic review.

Abstract

Combination therapy of sorafenib and transarterial chemoembolization (TACE) has shown benefits in treating advanced hepatocellular carcinoma (HCC). This study evaluated the efficacy and safety of TACE+sorafenib. MEDLINE, the Cochrane Library, EMBASE, and the ISI Web of Knowledge were searched (until 31 December 2013) for studies comparing TACE and TACE+sorafenib in treating patients with advanced HCC. Sensitivity and quality assessments were performed. Five comparative studies (2 were randomized control trials) that included 899 patients were used in the meta-analysis. Patients treated with TACE+sorafenib had better prognoses in terms of time to progression (TTP) compared to those with TACE+placebo or TACE alone; hazard ratios (HRs) ranged from 0.40 to 0.87, with the combined HR 0.61 (95% CI 0.39-0.95, p=0.031). However, the combined HR for overall survival (OS) did not differ significantly between patients treated with TACE+sorafenib and those with TACE+placebo or TACE alone (combined HR=0.79, 95% CI=0.54-1.16, p=0.235). Sensitivity analysis indicated the findings for TTP may be overly influenced by at least one of the studies. In summary, our meta-analysis found that TACE+sorafenib can improve TTP. We did not find the combined therapy improved OS. Additional randomized controlled studies are necessary to further investigate the clinical benefit of TACE+sorafenib in treating advanced HCC.