PDF(Pubmed)
Abstract：
UNASSIGNED: In 2020, atezolizumab-bevacizumab became the new standard of care (SOC) for first-line unresectable hepatocellular carcinoma (HCC) patients, following a decade where sorafenib was the preferred first-line treatment. In the last few years, a number of novel systemic treatments with non-inferiority and superiority to sorafenib have been approved as first-line treatments.
UNASSIGNED: The objective of this systematic literature review (SLR) and network meta-analysis (NMA) was to compare randomised controlled trial evidence for atezolizumab-bevacizumab with globally relevant pharmacological comparators for first-line treatment of patients with unresectable HCC.
UNASSIGNED: Randomised controlled trials investigating first-line treatment of HCC in adults with no prior systemic treatment were eligible for inclusion into the SLR and were retrieved from Embase, MEDLINE, and Evidence-Based Medicine (EBM) Reviews. Interventions of interest for the NMA included atezolizumab-bevacizumab, sorafenib, lenvatinib, durvalumab (including in combination with tremelimumab), cabozantinib (including in combination with atezolizumab), camrelizumab (including in combination with rivoceranib), pembrolizumab (including in combination with lenvatinib), and tislelizumab. Random effects NMA was conducted for survival endpoints within a Bayesian framework with an informative prior distribution for between-study heterogeneity. The hazard ratios for relative treatment effect were estimated with 95% credible intervals (CrIs).
UNASSIGNED: The SLR identified 49 studies, of which eight formed a connected evidence network permitting the indirect treatment comparison of atezolizumab-bevacizumab with comparators of interest. The indirect comparisons suggested an improved overall survival (OS) with atezolizumab-bevacizumab versus most comparators. All indirect treatment comparison results for atezolizumab-bevacizumab included the null value within the 95% CrI (n = 1) for OS and progression-free survival (PFS).
UNASSIGNED: The results of the NMA indicate atezolizumab-bevacizumab is associated with superior or comparable OS and PFS together with a manageable safety profile compared with globally relevant comparators in the unresected HCC indication. The findings support that atezolizumab-bevacizumab remains SOC for the management of first-line unresectable HCC patients.
UNASSIGNED: The objective of this systematic literature review (SLR) and network meta-analysis (NMA) was to compare randomised controlled trial evidence for atezolizumab-bevacizumab with globally relevant pharmacological comparators for first-line treatment of patients with unresectable HCC.
UNASSIGNED: Randomised controlled trials investigating first-line treatment of HCC in adults with no prior systemic treatment were eligible for inclusion into the SLR and were retrieved from Embase, MEDLINE, and Evidence-Based Medicine (EBM) Reviews. Interventions of interest for the NMA included atezolizumab-bevacizumab, sorafenib, lenvatinib, durvalumab (including in combination with tremelimumab), cabozantinib (including in combination with atezolizumab), camrelizumab (including in combination with rivoceranib), pembrolizumab (including in combination with lenvatinib), and tislelizumab. Random effects NMA was conducted for survival endpoints within a Bayesian framework with an informative prior distribution for between-study heterogeneity. The hazard ratios for relative treatment effect were estimated with 95% credible intervals (CrIs).
UNASSIGNED: The SLR identified 49 studies, of which eight formed a connected evidence network permitting the indirect treatment comparison of atezolizumab-bevacizumab with comparators of interest. The indirect comparisons suggested an improved overall survival (OS) with atezolizumab-bevacizumab versus most comparators. All indirect treatment comparison results for atezolizumab-bevacizumab included the null value within the 95% CrI (n = 1) for OS and progression-free survival (PFS).
UNASSIGNED: The results of the NMA indicate atezolizumab-bevacizumab is associated with superior or comparable OS and PFS together with a manageable safety profile compared with globally relevant comparators in the unresected HCC indication. The findings support that atezolizumab-bevacizumab remains SOC for the management of first-line unresectable HCC patients.
摘要：
■在2020年，阿妥珠单抗-贝伐单抗成为一线不可切除肝细胞癌（HCC）患者的新治疗标准（SOC），十年来，索拉非尼是首选的一线治疗。在过去的几年里，与索拉非尼相比,许多具有非劣效性和优越性的新型全身治疗方法已被批准为一线治疗.
■本系统文献综述（SLR）和网络荟萃分析（NMA）的目的是比较阿司珠单抗-贝伐单抗的随机对照试验证据与全球相关的药物比较，用于一线治疗不可切除的HCC患者。
■研究未接受过全身治疗的成人肝癌一线治疗的随机对照试验符合纳入SLR的条件，并从Embase检索。MEDLINE,和循证医学(EBM)评论。对NMA感兴趣的干预措施包括阿司珠单抗-贝伐单抗，索拉非尼,lenvatinib,Durvalumab（包括与曲美木单抗联合使用），卡博替尼（包括与阿特珠单抗联合使用），camrelizumab（包括与Rivoceranib联合使用），pembrolizumab（包括与lenvatinib联合使用），和tislelizumab。在贝叶斯框架内对生存终点进行随机效应NMA，并具有研究间异质性的信息先验分布。用95%可信间隔(CrIs)估计相对治疗效果的风险比。
■SLR确定了49项研究，其中8人形成了一个相互关联的证据网络,允许将阿特珠单抗-贝伐单抗与感兴趣的对照者进行间接治疗比较.间接比较表明，与大多数比较物相比，阿特珠单抗-贝伐单抗改善了总生存期（OS）。阿特珠单抗-贝伐单抗的所有间接治疗比较结果包括OS和无进展生存期(PFS)的95%CrI(n=1)内的空值。
■NMA的结果表明，在未切除的HCC适应症中，阿司珠单抗-贝伐单抗与优于或相当的OS和PFS以及可管理的安全性特征相关。研究结果支持阿妥珠单抗-贝伐单抗仍然是治疗一线不可切除的HCC患者的SOC。
■本系统文献综述（SLR）和网络荟萃分析（NMA）的目的是比较阿司珠单抗-贝伐单抗的随机对照试验证据与全球相关的药物比较，用于一线治疗不可切除的HCC患者。
■研究未接受过全身治疗的成人肝癌一线治疗的随机对照试验符合纳入SLR的条件，并从Embase检索。MEDLINE,和循证医学(EBM)评论。对NMA感兴趣的干预措施包括阿司珠单抗-贝伐单抗，索拉非尼,lenvatinib,Durvalumab（包括与曲美木单抗联合使用），卡博替尼（包括与阿特珠单抗联合使用），camrelizumab（包括与Rivoceranib联合使用），pembrolizumab（包括与lenvatinib联合使用），和tislelizumab。在贝叶斯框架内对生存终点进行随机效应NMA，并具有研究间异质性的信息先验分布。用95%可信间隔(CrIs)估计相对治疗效果的风险比。
■SLR确定了49项研究，其中8人形成了一个相互关联的证据网络,允许将阿特珠单抗-贝伐单抗与感兴趣的对照者进行间接治疗比较.间接比较表明，与大多数比较物相比，阿特珠单抗-贝伐单抗改善了总生存期（OS）。阿特珠单抗-贝伐单抗的所有间接治疗比较结果包括OS和无进展生存期(PFS)的95%CrI(n=1)内的空值。
■NMA的结果表明，在未切除的HCC适应症中，阿司珠单抗-贝伐单抗与优于或相当的OS和PFS以及可管理的安全性特征相关。研究结果支持阿妥珠单抗-贝伐单抗仍然是治疗一线不可切除的HCC患者的SOC。
