Meta-Analysis
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Jun 15, 2025; 17(6): 105887
Published online Jun 15, 2025. doi: 10.4251/wjgo.v17.i6.105887
Transarterial chemoembolization combined with lenvatinib vs transarterial chemoembolization combined with sorafenib for unresectable hepatocellular carcinoma: A systematic review and meta-analysis
Wei Zhang, Hua Fu, Zi-Rong Liu, Lin Xu, Xu Che, Yan-Ting Ning, Zheng-Yin Zhan, Guo-Chao Zhou
Wei Zhang, Zi-Rong Liu, Lin Xu, Xu Che, Zheng-Yin Zhan, Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen 518116, Guangdong Province, China
Hua Fu, Guo-Chao Zhou, Department of Hepatobiliary Surgery, People’s Hospital of Xiangxi Autonomous Prefecture, Jishou 416000, Hunan Province, China
Yan-Ting Ning, Department of Nursing, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen 518116, Guangdong Province, China
Co-first authors: Wei Zhang and Hua Fu.
Co-corresponding authors: Zheng-Yin Zhan and Guo-Chao Zhou.
Author contributions: Zhang W and Fu H were responsible for drafting the manuscript, data acquisition, and interpretation of the data, they contributed equally as co-first authors; Liu ZR, Xu L, and Che X were responsible for the design of the study; Ning YT, Zhan ZY, and Zhou GC were responsible for the design of the study and the revision of the manuscript; Zhan ZY and Zhou GC contributed equally to this article as co-corresponding authors.
Supported by the Shenzhen High-Level Hospital Construction Fund, the Sanming Project of Medicine in Shenzhen, No. SZSM202011010; Intramural Research Projects of Shenzhen Hospital, Cancer Hospital, Chinese Academy of Medical Sciences, No. SZ2020MS010; and the Scientific Research Program Fund of Hunan Provincial Health Commission, No. 202204014693.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
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: Guo-Chao Zhou, Department of Hepatobiliary Surgery, People’s Hospital of Xiangxi Autonomous Prefecture, Intersection of Century Avenue and Jianxin Road, Jishou 416000, Hunan Province, China. zhouguochao5506@sina.com
Received: February 10, 2025
Revised: March 25, 2025
Accepted: April 23, 2025
Published online: June 15, 2025
Processing time: 124 Days and 10.8 Hours
Abstract
BACKGROUND

Lenvatinib and sorafenib are tyrosine kinase inhibitors that are effective in the treatment of unresectable hepatocellular carcinoma (uHCC). The efficacy of which of them is better suited to combine transarterial chemoembolization (TACE) for the treatment of uHCC is ripe.

AIM

To compare the effectiveness of TACE combined with lenvatinib (TACE-lenvatinib) and TACE combined with sorafenib (TACE-sorafenib) in the treatment of uHCC, this study was carried out.

METHODS

Publicly available studies comparing the efficacy of TACE-lenvatinib and TACE-sorafenib in the treatment of uHCC were collected from PubMed, Embase and Cochrane Library, with a cut-off date of December 2024. Stata SE 15 software was used for statistical analysis.

RESULTS

A total of six studies involving 547 patients were included, 248 in the TACE-lenvatinib group and 299 in the TACE-sorafenib group. Meta-analysis results showed that TACE-lenvatinib was more effective than TACE-sorafenib in complete response [relative risk (RR) = 1.81, 95% confidence interval (CI): 1.11-2.96, P = 0.02], partial response (RR = 1.38, 95%CI: 1.12-1.70, P = 0.002), objective response rate (RR = 1.47, 95%CI: 1.24-1.74, P < 0.0001) and disease control rate (RR = 1.22, 95%CI: 1.00-1.49, P = 0.05). TACE-lenvatinib was significantly lower than TACE-sorafenib in progressive disease rate (RR = 0.54, 95%CI: 0.39-0.74, P = 0.002). No significant difference was found in stable disease rate (RR = 0.89, 95%CI: 0.60-1.33, P = 0.58) between the two groups. TACE-lenvatinib was significantly more effective than TACE-sorafenib in overall survival (hazard ratio = 2.00, 95%CI: 1.59-2.50, P < 0.05) and progression free survival (hazard ratio = 2.04, 95%CI: 1.49-2.86, P < 0.05). As regards adverse events, TACE-lenvatinib was better in reducing the incidence of hypertension than TACE-sorafenib, while no significant difference was found in overall adverse events, abdominal pain, fever, fatigue, nausea and vomiting, decreased appetite, liver dysfunction, hand-foot skin reaction, diarrhea, thrombocytopenia, and rash between the two groups.

CONCLUSION

In patients with uHCC, TACE-lenvatinib induced a better tumor response rate and survival outcome than TACE-sorafenib, while TACE-lenvatinib resulted in a higher incidence of hypertension than TACE-sorafenib. However, these conclusions are derived from currently available medical evidence, and further confirmation by more rigorously designed randomized controlled studies is still needed.

Keywords: Hepatocellular carcinoma; Lenvatinib; Sorafenib; Transcatheter arterial chemoembolization; Meta-analysis

Core Tip: In this study, we compared the efficacy of transarterial chemoembolization (TACE)-lenvatinib and TACE-sorafenib against unresectable hepatocellular carcinoma. The TACE-lenvatinib group had higher tumor response rate than the TACE-sorafenib group. We also found that both overall survival and progression-free-survival were higher in the TACE-lenvatinib group than in the TACE-sorafenib group. The TACE-lenvatinib group had a higher incidence of hypertension. Therefore, the combination of TACE and lenvatinib resulted in better tumor response rates and survival outcomes in unresectable hepatocellular carcinoma patients compared to TACE-sorafenib, although the former was associated with a higher incidence of hypertension.