Evidence-Based Management of Hepatocellular Carcinoma: Systematic Review and Meta-analysis of Randomized Controlled...

Area of Science:

• Hepatology
• Oncology
• Clinical Trials Research

Background:

• Hepatocellular carcinoma (HCC) is a major cause of cancer mortality with evolving treatment options.
• Numerous randomized controlled trials (RCTs) have been conducted over the past two decades to improve HCC patient outcomes.
• Analyzing these trials is crucial for understanding treatment efficacy and influencing factors.

Purpose of the Study:

• To systematically review phase III RCTs for HCC treatments from 2002-2020.
• To conduct a meta-analysis examining the relationship between etiology and treatment outcomes.
• To identify factors influencing patient response to systemic therapies like tyrosine-kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs).

Main Methods:

• Systematic review of phase III RCTs in HCC across all disease stages.
• Meta-analysis of 8 trials (3739 patients) comparing ICI and TKI/anti-VEGF therapies.
• Inclusion of high-quality RCTs identified through a rigorous screening process.

Main Results:

• 49 high-quality RCTs involving 22,113 patients were included.
• Nine trials yielded positive results, leading to guideline adoption for six treatments.
• Meta-analysis indicated ICI therapy was more effective in viral hepatitis-related HCC than nonviral etiologies; TKIs showed no etiological differences.

Conclusions:

• The study identified 9 positive RCTs out of 49 high-quality trials in HCC.
• Systemic therapies, particularly immunotherapies, demonstrate differential efficacy based on etiology.
• Immune checkpoint inhibitors show enhanced effectiveness in patients with viral hepatitis-related HCC.