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First-line targ veted therapies of advanced hepatocellular carcinoma: A Bayesian network analysis of randomized

Wei Ding1,2, Yulin Tan1,2, Yan Qian3

  • 1Department of General Surgery, Wujin Hospital Affiliated with Jiangsu University, Changzhou, China.

Plos One
|March 6, 2020
PubMed
Abstract

Insights

This study compared targeted drugs for advanced hepatocellular carcinoma (HCC). Vandetanib showed promise for improved overall survival (OS) and safety, but evidence quality is low, highlighting the need for new treatments.

Area of Science:

  • Oncology
  • Pharmacology
  • Clinical Trials

Background:

  • Targeted therapies have emerged as effective treatments for advanced hepatocellular carcinoma (HCC).
  • Evaluating the comparative efficacy and safety of these drugs is crucial for optimizing first-line treatment strategies.

Purpose of the Study:

  • To conduct a Bayesian network meta-analysis comparing the efficacy and safety of various targeted drugs for first-line treatment in advanced HCC.
  • To identify the most effective and safest targeted drug options based on available clinical trial data.

Main Methods:

  • A systematic literature search was performed across PubMed, Embase, and Cochrane Library for relevant randomized controlled trials (RCTs).
  • Hazard ratios (HRs) for time to progression (TTP), overall survival (OS), and progression-free survival (PFS) were calculated.
  • Odds ratios (ORs) for objective response rate (ORR) and Grade 3-5 adverse events (G3-5AE) were determined.
  • Bayesian network meta-analyses were employed to pool data, and drug rankings were generated using the surface under the cumulative ranking curve (SUCRA).

Main Results:

  • Twenty-two RCTs involving 9288 patients were analyzed.
  • Brivanib, linifanib, lenvatinib, and sorafenib demonstrated significant improvements in TTP compared to placebo.
  • Vandetanib and sorafenib showed significant improvements in OS compared to placebo.
  • No significant differences were observed in PFS, ORR, or G3-5AE across the evaluated drugs.
  • Vandetanib was identified as potentially the most effective (OS) and safest (G3-5AE) option, followed by nintedanib, though with low quality of evidence.

Conclusions:

  • Vandetanib, linifanib, lenvatinib, and nintedanib may serve as viable alternatives to sorafenib for first-line treatment in advanced HCC.
  • Vandetanib appears to be a promising option, but further research is needed due to low evidence quality.
  • The development of novel targeted therapies is essential to improve survival outcomes for HCC patients.

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