Meta-Analysis
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Jul 15, 2024; 16(7): 3308-3320
Published online Jul 15, 2024. doi: 10.4251/wjgo.v16.i7.3308
Clinical benefits of transarterial chemoembolization combined with tyrosine kinase and immune checkpoint inhibitors for unresectable hepatocellular carcinoma
Feng Han, Xiao-Han Wang, Chen-Zhou Xu
Feng Han, Xiao-Han Wang, Chen-Zhou Xu, Department of Gastroenterology, The First Hospital of Jiaxing, The Affiliated Hospital of Jiaxing University, Jiaxing 314001, Zhejiang Province, China
Author contributions: Han F was responsible for acquisition of data, analysis and interpretation of data, drafting the article, final approval; Wang XH was responsible for interpretation of data, revising the article, final approval; Xu CZ was responsible for conception and design of the study, critical revision, final approval.
Supported by Jiaxing Public Welfare Research Project, No. 2022AD30046.
Conflict-of-interest statement: Dr. Xu has nothing to disclose.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chen-Zhou Xu, MM, Doctor, Department of Gastroenterology, The First Hospital of Jiaxing, The Affiliated Hospital of Jiaxing University, No. 1882 Zhonghuan South Road, Jiaxing 314001, Zhejiang Province, China. jxsdyyyxcz@zjxu.edu.cn
Received: April 24, 2024
Revised: May 17, 2024
Accepted: May 20, 2024
Published online: July 15, 2024
Processing time: 79 Days and 5.4 Hours
Abstract
BACKGROUND

Combination therapy has emerged as the focus of research for unresectable hepatocellular carcinoma (HCC). In recent years, several studies have explored the clinical efficacy and safety of the combination therapies of transarterial chemoembolization (TACE) with tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs).

AIM

To conduct an updated meta-analysis verifying the clinical benefits and adverse effects of the triple combination therapy for unresectable HCC.

METHODS

All eligible cohort, non-randomized controlled, and randomized controlled trial studies from the PubMed, Web of Science, Embase, Cochrane Library, and MedLine databases up to March 20, 2024 were screened for the present meta-analysis. The study endpoints included complete response (CR), objective response rate (ORR), disease control rate (DCR), overall survival (OS), progression-free survival (PFS), and adverse events (AEs). Stata 16/18 software was used for this meta-analysis, and a P value of <0.05 was considered statistically significant.

RESULTS

A total of 29 studies with 1754 patients were included. Among the patients who received the TACE therapy with TKIs and ICIs, the tumor response results revealed a pooled CR, ORR, and DCR of 14% [95%CI (0.11–0.18)], 61% [95%CI (0.55–0.66)], and 85% [95%CI (0.83–0.87)], respectively. In terms of the survival outcomes, the pooled median PFS and OS were 10.25 months [95%CI (9.31–11.18)] and 20.47 months [95%CI (18.98–21.97)], respectively. The pooled prevalence of all-grade AEs during the triple treatment was 90% [95%CI (0.84–0.94)] and that of grade ≥ 3 AEs was 32% [95%CI (0.24–0.42)].

CONCLUSION

The combination therapy of TACE, TKIs, and ICIs exhibits great clinical benefits for unresectable HCC in terms of tumor responses and survival outcomes without increasing the risk of severe AEs.

Keywords: Transarterial chemoembolization; Tyrosine kinase inhibitors; Immune checkpoint inhibitors; Hepatocellular carcinoma; Meta-analysis

Core Tip: Consensus regarding the treatment of unresectable hepatocellular carcinoma (HCC) currently remains lacking. The triple combination therapy of transarterial chemoembolization with tyrosine kinase and immune checkpoint inhibitors has attracted significant attention as an aggressive treatment strategy and has been used for treatment in recent years. We conducted a systematic review and updated meta-analysis to verify the clinical benefits and adverse effects of triple therapy in 29 studies with 1754 patients with unresectable HCC. The complete response, objective response rate, disease control rate, overall survival, progression-free survival, and adverse events induced by the triple therapy were evaluated.