背景:联合治疗已成为不可切除的肝细胞癌(HCC)的研究重点。近年来,多项研究探讨了经动脉化疗栓塞(TACE)与酪氨酸激酶抑制剂(TKIs)和免疫检查点抑制剂(ICIs)联合治疗的临床疗效和安全性.
目的:进行更新的荟萃分析,验证三联疗法治疗不可切除的HCC的临床益处和不良反应。
方法:所有符合条件的队列,非随机对照,和PubMed的随机对照试验研究,WebofScience,Embase,科克伦图书馆,和截至2024年3月20日的MedLine数据库进行了本荟萃分析筛选。研究终点包括完全缓解(CR),客观反应率(ORR),疾病控制率(DCR),总生存期(OS),无进展生存期(PFS),和不良事件(AE)。Stata16/18软件用于此荟萃分析,P值<0.05被认为具有统计学意义。
结果:共纳入29项研究,共1754例患者。在接受TKIs和ICIs的TACE治疗的患者中,肿瘤反应结果显示合并的CR,ORR,和DCR为14%[95CI(0.11-0.18)],61%[95CI(0.55-0.66)],和85%[95CI(0.83-0.87)],分别。就生存结果而言,合并的中位PFS和OS分别为10.25个月[95CI(9.31-11.18)]和20.47个月[95CI(18.98-21.97)],分别。三联治疗期间所有级别AE的合并患病率为90%[95CI(0.84-0.94)],≥3级AE的合并患病率为32%[95CI(0.24-0.42)]。
结论:TACE联合治疗,TKIs,在肿瘤反应和生存结果方面,ICI和ICI对不可切除的HCC具有巨大的临床益处,而不会增加严重AE的风险。
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).
OBJECTIVE: 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)].
CONCLUSIONS: 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.