■经动脉化疗(栓塞)是治疗不可切除的肝细胞癌(uHCC)的首选方法;然而,因为新兴的免疫靶向疗法,它的功效岌岌可危。本系统综述是评估经动脉化疗(栓塞)联合免疫靶向治疗对uHCC患者的临床疗效和安全性的先驱。
■PubMed,Embase,在2024年5月31日之前,对Cochrane图书馆进行了比较免疫靶向治疗加或不加经动脉化疗(栓塞)的研究.完全响应(CR)率,客观反应率(ORR),和疾病控制率(DCR)被认为是经动脉化疗(栓塞)联合免疫靶向治疗的临床结果计算的主要结果,无进展生存期(PFS)和总生存期(OS)。将治疗相关严重不良事件的发生率作为安全性结果的主要指标。
■16项研究,包括1,789例接受经动脉化疗(栓塞)加免疫靶向治疗的患者和1,215例仅接受免疫靶向治疗的患者,被认为是合格的。经动脉化疗(栓塞)和免疫靶向治疗的组合显示CR的结局增强(OR=2.12,95%CI=1.35-3.31),ORR(OR=2.78,95%CI=2.15-3.61),DCR(OR=2.46,95%CI=1.72-3.52),PFS(HR=0.59,95%CI=0.50-0.70),和OS(HR=0.51,95%CI=0.44-0.59),尽管伴有ALT激增(OR=2.17,95%CI=1.28-3.68)和AST(OR=2.28,95%CI=1.42-3.65)。在一线治疗的亚组中也验证了额外的经动脉化疗(栓塞)对免疫靶向治疗的优势,干预技术,有或没有肝外转移,Child-PughA级或B级,有或没有肿瘤血栓。
■经动脉化疗(栓塞)和免疫靶向治疗的组合似乎可以增强uHCC的局部控制和长期疗效,尽管以肝脏并发症为代价。
■http://www.crd.约克。AC.英国/PROSPERO/,标识符474669。
UNASSIGNED: Transarterial chemo(embolization) is preferred for treating unresectable hepatocellular carcinoma (uHCC); however, because of emerging immune-targeted therapies, its efficacy is at stake. This systematic review pioneers to evaluate the clinical efficacy and safety of transarterial chemo(embolization) combined with immune-targeted therapy for uHCC patients.
UNASSIGNED: PubMed, Embase, and Cochrane Library were searched for studies comparing immune-targeted therapy with or without transarterial chemo(embolization) until 31 May 2024. The complete response (CR) rate, objective response rate (ORR), and disease control rate (DCR) were considered to be the primary outcomes calculated for the clinical outcomes of transarterial chemo(embolization) combined with immune-targeted therapy, along with progression-free survival (PFS) and overall survival (OS). The incidence of treatment-related severe adverse events was set as the major measure for the safety outcome.
UNASSIGNED: Sixteen studies, encompassing 1,789 patients receiving transarterial chemo(embolization) plus immune-targeted therapy and 1,215 patients receiving immune-targeted therapy alone, were considered eligible. The combination of transarterial chemo(embolization) and immune-targeted therapy demonstrated enhanced outcomes in CR (OR = 2.12, 95% CI = 1.35-3.31), ORR (OR = 2.78, 95% CI = 2.15-3.61), DCR (OR = 2.46, 95% CI = 1.72-3.52), PFS (HR = 0.59, 95% CI = 0.50-0.70), and OS (HR = 0.51, 95% CI = 0.44-0.59), albeit accompanied by a surge in ALT (OR = 2.17, 95% CI = 1.28-3.68) and AST (OR = 2.28, 95% CI = 1.42-3.65). The advantages of additional transarterial chemo(embolization) to immune-targeted therapy were also verified in subgroups of first-line treatment, intervention techniques, with or without extrahepatic metastasis, Child-Pugh grade A or B, and with or without tumor thrombus.
UNASSIGNED: The combination of transarterial chemo(embolization) and immune-targeted therapy seems to bolster local control and long-term efficacy in uHCC, albeit at the expense of hepatic complications.
UNASSIGNED: http://www.crd.york.ac.uk/PROSPERO/, identifier 474669.