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Efficacy and safety of transarterial chemoembolization combined with tyrosine kinase inhibitors with or without PD-1 inhibitors for advanced hepatocellular carcinoma: a meta-analysis
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Abstract:
Objective: To evaluate the efficacy and potential adverse effects of transarterial chemoembolization (TACE) combined with tyrosine kinase inhibitors (TKIs) [TT] with or without PD-1 antibody (PD-1Ab) (TT + PD-1Ab vs TT alone) in the treatment of advanced hepatocellular carcinoma (aHCC). Methods: A literature search was conducted across PubMed, CNKI, Embase, and Web of Science from database inception to January 31, 2024. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Meta-analysis was performed using Stata16.0 software. Results: A total of 17 studies involving 2 334 patients were included. The meta-analysis results showed that: Compared with TT therapy, the addition of PD-1 antibody significantly improved overall survival [HR = 0.44, 95% CI (0.36, 0.51), P < 0.000 01 ], progression-free survival[HR = 0.47, 95% CI (0.42, 0.52), P < 0.000 01], objective response rate (ORR) [HR = 1.65, 95% CI (1.46, 1.86), P < 0.000 01], and disease control rate (DCR) (HR = 1.26, 95% CI [1.15, 1.38], P < 0.000 01); aHCC patients with different baseline characteristics such as ECOG-PS, extrahepatic metastasis, BCLC stage, tumor size, Child-Pugh score, and hepatic portal vein invasion benefited from TT + PD-1Ab therapy; There was no significant difference in the overall incidence of all-grades and ≥ grade 3 adverse events (AEs) between the two regimens, but symptoms such as hypertension, hypothyroidism, and reactive cutaneous vascular proliferation were more common in patients treated with TT + PD-1Ab. Conclusion: Compared with the TT therapy, the addition of PD-1Ab can significantly extend OS and PFS and improve the ORR and DCR in patients with aHCC. The overall incidence of all-grades and ≥ grade 3 AEs was not significantly increased in the TT PD-1 Ab group, with good overall tolerability, although higher rates of hypertension, mucocutaneous, and thyroidrelated AEs were observed in the TT + PD-1Ab group and should be closely monitored.
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